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The internet is ablaze with images and commentary about our new president. They focus on a baby blue dress with an interesting collar or lack of chivalry or delusional views of a crowd or pithy signs about that which cannot be combed over, but let me tell you what I do and don’t care about when it comes to our new president.

I don’t care what his wife wears; but, I do care about how his trade policies will impact the price of everyone else’s clothes since most Americans cannot afford 4-figure price tag garments made in America.

I don’t care how he treats his wife or the two wives that preceded her; but, I do care about what he is doing to dismantle women’s healthcare and reproductive choice.

I don’t care what size of his crowds were compared to my crowds; but, I do care that he has no qualms about every person in either of those crowds or in any other public space carrying a loaded weapon.

I don’t care how bad his spray tan is or how awkward his combover looks when the wind gusts; but, I do care that he is going to decimate our environment and exacerbate global warming.

I don’t care about his son’s personality or medical history; but, I do care that he is going to dismantle a public school system and higher education financing mechanism that educates the rest of our children.

I don’t care that he hasn’t released his tax returns; but, I do care that he intends to give the top 1% tax cuts while everyone else pays more and loses necessary services.

I don’t care that he is not as amazingly healthy as his hyperbolic doctor purported him to be; but, I do care that he is going to significantly reduce access to health care for millions of our most vulnerable citizens.

I don’t care that he was obsessed with promulgating the “alternative fact” that our 44th President was not born in the US; but, I do care about him oppressing those among us who were not born here especially if we do not bear a white European ethnicity or do not practice Christianity.

When our new president cares only about stroking his own ego and pandering to those who simply cannot tolerate a progressively diverse society and increasingly global economy, we must have a laser like focus on the values and policies we really care about.

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I, as an individual, am as pretty WASP-y as you can get. I am white, middle class, Protestant, grew up mostly in the South, and come from a military family – my grandfather was in the Army, my brother was in the Marines, and I have 3 uncles who served in the Navy. So, when I first heard about and subsequently saw Colin Kaepernick’s response to the National Anthem, it stung.

Okay, I’m hedging. It more than stung. I thought it was disrespectful and I flat out disagreed with it.

Yeah, yeah, my family members served to preserve his right of free speech, I get it. Now, I am not in any way going to condone his other choices, but I am going to specifically address his choice to kneel during the National Anthem. I thought what he was doing was wrong.

I now realize I am the one that was wrong, and here is why.

I have written previously regarding my feelings about the current state of our country, working alongside members of law enforcement every day, being married to a black man, and being the mother of two biracial boys. The current level of violence in this country, American citizen on American citizen, is nauseating. And we are scared – black, white, police, non-police.

WE ARE SCARED.

For each other, our neighbors, our friends, our husbands, our wives, our sons, our daughters. And we are letting that FEAR WIN. I have realized… even in 2016, we are still very much of country of “us” vs “them”.

I have listened to so many people talk about how Colin Kaepernick is being disrespectful by kneeling. Military, non-military, men, women…. but all mostly white.

And that got me thinking. I started thinking about race relations in this country, and I started thinking about my own family, and my fears for my children. If I had something to say, once my children started driving and I began to pray for them to come home safely every night… not just in fear of a car accident, but in fear of them getting shot… How could I draw attention to it? How could I get my voice heard? How could I start a national conversation to actually help the situation, and make some progress?

So I had to ask myself, how do “we” (White America) want “them” (Black America) to protest? To show their fear? To demonstrate their pain?

We complained in the 1960s with sit-ins and boycotts (“they are interrupting businesses”), we judge harshly with riots (“they are being violent”), and the church prayer meetings largely get ignored. So how, in this day and age, are we going to allow a population of people in the United States, the “land of the free” be heard? How are “we” going to allow “them” to start a conversation with “us”?

My guess is, Colin Kaepernick is scared for this country. I know I am.

As a trauma surgeon, I am the one behind the scenes, with my hands covered in the blood of the injured. Their blood not only stains my skin, it stains my soul.

The patients I have lost live forever in my mind. Enough blood has already been spilled onto our streets. With all the violence that is happening, why can’t we prioritize our feelings and support a non-violent means of expression? He is nonviolently expressing his fear, his anger over what is happening by kneeling. He’s not turning his back. He’s not burning anything. He isn’t breaking into a building, or throwing rocks at police. He is kneeling, which is still a position of respect. A man kneels to ask a woman to become his wife. People kneel to pray. And he is bringing attention to an issue that should be in all of our minds and on all of our hearts.

As Americans, regardless of race, we should be encouraging non-violent means of communication, and kneeling during our National Anthem, is one of them. I’m not saying everyone should sign up for the Colin Kaepernick fan club, but what I am saying is that we should stop focusing on the how of the protest and start focusing on the why of the protest. The only way for there to not be an “us” and “them” is to allow each other to not only speak, but also to be heard.

So, White America, I encourage all of us to put on the hearing aids, and start listening.

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Otis was our first baby. He was covered in a caramel colored fur, weighed 150 pounds and was the best Bullmastiff dog anyone could ask for. He protected me from my husband’s incessant tickle attacks and thought that my lap was the best place for him to try and sit.

Two years ago, I was walking Otis and he suddenly collapsed. After an extensive workup including an EKG, blood work and an ultrasound of his heart by the doggie Cardiologist (yes, they do exist), we started him on a new regimen of medications for his heart failure. It cost $300 a month but was worth every penny – almost overnight he was a new dog, back to his usual daily routine and enjoying all the activities he loved most in the world.

About a year later though, he started declining again. His favorite spot to sleep was on the floor, right next to my side of the bed. But our bedroom was upstairs, and he just couldn’t make it anymore. He had to sleep by himself. He couldn’t go on walks. He slowly but surely began to get left out of family activities, and for a dog who was as much a part of our family as a pet could be, this was life-altering. He couldn’t participate in any activity which had previously given him joy. He was becoming more and more isolated, becoming physically separated from the people he loved most in the world.

That’s when I knew – it was time to say goodbye. It still hurts, but I know it was the most unselfish and loving thing I could do – focus on him, his wants and his needs, instead of me and my own.

As a trauma and critical care surgeon, all too often I see families struggle in the intensive care unit with loved ones who have devastating diagnoses and injuries.

Now if only most of us treated our parents and loved ones as we do our pets – knowing and respecting their wishes, valuing the quality of their life over the quantity.

Granted, I never had to ask Otis what he enjoyed in life, what his priorities were or what kind of life he wanted to lead – it was pretty self-evident. Your loved ones are clearly more complicated than that, and that’s even more reason their wishes should be known. Do they want to be kept alive by machines with no hope of a recovery that would allow them to participate in their favorite activities? Or be able to participate in relationships with their family? Do they want you to try everything no matter what the outcome might be? If they cease to enjoy eating and can’t communicate anymore, do they want you to put a feeding tube in them? These are the types of questions and conversations that I implore you to ask and have with your family members – no matter their age, no matter how healthy they are at this very moment, because things can change for any of us… in an instant.

In situations like these, my role as the intensive care physician caring for your family member is to find out what HE or SHE would want if they could speak for him or herself, not what anyone else wants. But I’ll never know your loved one like you do. I don’t know what they value in life, what they hold most dear. That’s why I need YOU to help me help them live or even die in the manner they’d want. Because let me tell you, there are a lot of things I can “do”. But your job is to help me make sure I’m doing these things for your loved one, not to them. I’m not asking you to make a decision, I’m asking you to tell me more about them. You aren’t “turning off” any machines, you’re telling me what kind of life your loved one wants… or doesn’t want, and it’s my job to help make that happen to the best of my ability.

Many of you may already know the answers to these tough questions, but I know just as many of you may not. Nope, it’s not going to be a fun conversation. You’re not going to enjoy it. But don’t let your fear of the conversation prevent you from being able to speak for your loved one because they physically can’t. Don’t let your discomfort then put you in a situation whereby you’re not honoring your loved one’s wishes, simply because you don’t know how they’d want their life to end. The greatest sign of love is selflessness – be selfless enough to have the conversation. Be selfless enough to honor their wishes. And know, when the time comes, you’re showing your love in the most profound way possible.

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A colleague of mine was recently questioning her capabilities having lost yet another patient who had arrived nearly lifeless after being shot. She was despondent over the nation’s overall complacency about our gun violence epidemic giving her far too many opportunities to fail or succeed as a trauma surgeon. Truthfully, neither quick decisive action nor expert surgical skill was enough to repair that much damage. Not in the hands of any trauma surgeon.

As trauma surgeons we bring everything we have–every ounce of energy and drive, countless years of specialized training, and an ever expanding armamentarium of medical technology to fix broken bodies–to our work but sometimes we simply feel like failures, both unable to save our patients and unable to move the dial on policies that might ameliorate gun violence.

Here are the words of support that I offered to my friend: a compassionate, highly skilled trauma surgeon who without hesitation took a hemorrhaging gun shot wound victim to the OR to try to save his life:

“The grief is understandable. For your patients. For your community. For our society. You have a skill set that makes you brave enough to even try, my friend. As a trauma surgeon when you hear audible hemorrhage you run toward it, just like the police run into the gunfire or the firefighters run into the flames. Each and every patient is lucky to have you and your strength; their families will be grateful for your efforts and empathy no matter the outcome. Don’t be too hard on your self.”

Having been raised in a culture of morbidity & mortality conferences where we scrutinize every decision and every action preceding a death or complication, having a chosen specialty whose goal is to salvage badly damaged bodies, and living in a world where these patients keep appearing in our trauma bays even when we speak up about gun violence, this self-doubt is common among us.

But sometimes we just needed to be reminded we are heroes who have chosen to run toward the audible bleeding so we can get up and go back to work the next day.

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Nope, not a better mother than your neighbor, than your friend, or than the president of your local PTA…but what makes you the best mother you can be? Going even further than that… What makes you successful as a person? As a human being?

John C. Maxwell defines “success” as:

“knowing your purpose in life,

growing to reach your maximum potential, and

sowing seeds that benefit others”.

Very recently I was approached by www.inspiringwomeninsurgery.com to provide some words of advice or encouragement, and while my 4 year old was brushing his teeth at night I thought about work/life “balance”, envisioned a set of scales, and came up with this.

Why am I a #bettermother because I am a surgeon? Because I know my purpose in life, I am growing and I am sowing seeds. I know that this mother may be sad that I miss my son’s soccer practices, but I also know there are lots of other mothers out there that are glad I did… because I was able to help their children in their time of need. And although my children may miss me at times, I know they also gain valuable lessons from my career – independence and selflessness chief among them. My children always know that I love them, and they are important to me… whether I am sitting at their bedside, or at the bedside of one of my patients.

And no, you don’t have to be a trauma surgeon or work outside the home to be successful, or a #bettermother. Again, look at the definition. Nowhere in that definition does it mention spending every moment of every waking day with your child(ren). It doesn’t mention making your child’s first birthday cake by hand, or becoming Vice President of a company. Nor does it mention “leaning in” to the point that you are about to fall over.

YOU are at the center of your success, and you have to give back to yourself in order to be in a position to give to others – whether that is your spouse or your children or your community.

An example for you. The wife of one of my partners volunteers with her daughters’ Girl Scout troop. This makes her a #bettermother – not because she spends time in an activity that involves her own children, but because she gives of her time to an activity that gives many children joy when other mothers can’t. Another friend is a #bettermother because she is a Crossfit addict… She is teaching her daughter that strong is beautiful, and physical health helps build emotional health.

Taking time in activities, away from your family, work related or not, that develop your sense of self, fulfill your purpose in life, and replenish your soul is not selfish. In fact, it is essential to being a #bettermother and a successful human being.

So what makes you a #bettermother? Is it the 30 minutes you spent exercising this morning? Or is it the 2 hours over the weekend you took to train for a marathon? Is it the overnight business trip in another city that allowed you to present a project that will better your company? Is it the hours you spend volunteering at your child’s school because other mothers can’t? Is it that extra time you took at the hospital treating a patient who needed you? Is it the time you spend organizing a book club giving women the opportunity to fellowship with other women, building their support system?

Success doesn’t require a title, or a degree, or a paycheck. It requires YOU being the best YOU possible.

So take that time to develop yourself, replenish yourself, fulfill your purpose.

Enjoy it. Own it. And snap a photo of yourself doing it. To keep as a reminder – when you are coming home late, or have 18 loads of laundry piled up, or serve Cheerios for dinner for the umpteenth time that week, or in any way feeling like you are “failing”…that you are, indeed, not.

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“Please don’t cut off my pants,” he pleaded. “I am homeless and they are my only pants. Please.”

He could say these words as we were conducting our initial assessment in the trauma bay so at least he was hemodynamically stable with an intact airway at that moment in time. However, he had arrived seconds earlier with potentially life threatening injuries as a level 1 trauma activation. Based on the location of wounds that were visible on his torso this was a real possibility so we needed to quickly conduct our secondary assessment. That meant rapid exposure by taking the trauma shears, one on each pant leg from my assistants, as we examined him from head to toe, front to back, in every crevice or crease that might hide a wound.

I looked him straight in the eye and said “Don’t worry. We will get you a pair of pants but right now we have to take care of you.”

Straight in the eye.

He relented. How could he not? The pants were already cut off even as I made eye contact. The process takes just seconds in the hands of a coordinated trauma team.

He was a very polite young man. He didn’t yell or kick or scream. He followed all of our instructions. He quietly told us his health, social, and family history. He told us he was scared. His life story mirrored that of many of our trauma patients: food insecurity, lack of affordable housing, few resources for education and job training, addiction, interpersonal violence, an endless vicious cycle. He was caught in that cycle and it was obvious that he was heartbroken to be there. He wanted a better life and tonight in the trauma bay, without his pants, he had failed once again to break it.

I always say that I was attracted to a career in trauma surgery because I am part surgeon and part social worker. In reality neither I nor the social worker employed by my hospital to help patients in need of socioeconomic support have much to offer our patients with these very real struggles. The policy level changes and investments that would bring grocery options, better schools, safe and affordable housing to our most underserved areas are not in our control. Even for those patients who want to make a change there are too few addiction treatment beds and job training programs. While these issues are clearly predictors of health, they are managed partly (addiction services) or entirely (basically everything else) outside of the healthcare system.

Yet every day we see the ravaging effects of socioeconomic insecurity on our population’s safety and well-being when they become our patients. We open the trauma bay doors and provide the full armamentarium of modern medicine to save a life acutely while feeling powerless to save lives at the societal level*.

We finished examining and working up our patient. He was not going to die that night and could be discharged. Discharged where? It was 3 in the morning. The social worker could give him the address of a shelter in town. There might be a bunk free. She could refer him to addiction treatment. There might be an available bed. A local non-profit might intervene in the light of day if we could make the connection. But we had no way to guarantee that this man, who was lucky to be alive, would not simply just slip back into his otherwise unlucky life after discharge.

Oh, and there weren’t even any pants to give him. The social worker’s closet of donation was empty of men’s pants it turns out**.

This was not something the trauma team to could bear. We might not be able to provide our patient with better groceries, housing, or addiction treatment to this man who in all of his words and actions as our trauma patient showed us a deep hope to be in a better place in life; but the least we could do is provide him the dignity of a pair of pants to head back into his unfair reality.

So we pooled our cash on hand, asked him what size he wore, and waited until the local Target and Kohl’s opened***. The next morning the light in his face and the sincere words of gratitude when he saw his new jeans and a back up pair of track pants and shorts felt like as much of an accomplishment as stabilizing the unstable patients who had entered the trauma bay earlier or the exploratory laparatomy we had done.

*NB: Most trauma centers do provide targeted injury prevention like helmet, seat belt, or firearms safety education through small investments or grant funding but these typically address to specific injury mechanisms rather than social policy.

**Men be like the ladies and cull your closets seasonally; donate to your local trauma center.

***If any Kohl’s or Target folks are reading this consider donating items or gift cards to your local trauma center.

The police officer got out, and began to walk to the vehicle. As he approached the driver’s side of the vehicle, he saw the large black man behind the steering wheel and moved to put his hand on the butt of his gun. The driver, sensing the change in dynamic, immediately shoved both hands out through the open window and called out it was okay for the officer to approach the car.

That “large black man” is my husband.

I was just featured in an article in Forbes, and I was chiding Americans for not discussing end of life topics with their loved ones just because it is uncomfortable. However, I am ashamed to admit that I have fallen victim to this myself. Dr. Brian Williams, a friend and colleague of mine, recently had an interview on CNN that reminded me of my own failure, because I have not addressed this aspect of my life before now. And this was consciously done because I found it to be uncomfortable… But no more.

The situation occurring in America now can not tolerate any more non-discussion because the topic is “uncomfortable”… So here we go.

As a trauma surgeon, I have a wonderful and unique relationship with law enforcement. We work side by side, and a day never goes by without some interaction between myself and an officer or detective. We testify at trials and all too often we take care of them when they are injured. I treasure this relationship with the people who keep us safe. It is important to me, and one that I enjoy immensely. However, I know that I live in conflict.

I am married to an amazing man who has been my best friend for the past 16 years. He happens to be black, and I happen to be white. Although I know him to be the wonderful husband and father that he is, that he has so many accomplishments both from the football field and now in law school, I also know he is “just” a black man to the police.

I fear for him.

Right after the shootings occurred in Dallas, I called him with tears in my eyes, and reminded him to be careful. To make sure his tail lights always work. To not go a single mile per hour over the speed limit. To do everything in his power to prevent any encounter with law enforcement… Because I know that his 6’6″ 300 pound frame makes people, and especially the police, nervous.

When we were in college together, I got sick with a terrible stomach flu, and he took me to the emergency department. It was 3:00 in the morning because he was in 2 a days for football and we needed to get home before his early morning run. Shortly after we arrived, another black man, approximately 5’10” and 160 pounds, entered the emergency department with blood on his face and shirt. Two police officers entered the emergency department about 15 minutes later… One white, and one black. The white officer beelined to my then boyfriend, now husband and began to question him, while the black officer watched.

Which leads me to my point… How can we make this better? How can we prevent more innocent lives from being lost- regardless of gender, race, or occupation? Because yes, All Lives Matter.

It has been a campaign in inner city communities “If you see something, say something”. This is an effort to encourage community members to tell the police if they see illegal activity, to make their community better.

Well, quite frankly this movement needs to move across not only racial lines, but the Blue Line. Police shootings should be investigated by an agency other than their own. When a police officer sees another officer acting in an inappropriate way, or begin to question clearly the wrong black man, they need to be able to say something- to that officer, to their superior, whomever.

Far too many young black men fit an unfortunate stereotype. We need to educate, provide opportunities and invest in their future so this stereotype no longer exists.

We need to engage each other… Black, white, law enforcement officer and civilian. We need to have these difficult and uncomfortable conversations, and even more importantly as Dr. Williams so eloquently stated, we need to start Listening to each other, really listening.

I not only see, hear, and understand both sides of the coin, I live them. I am in pain over the losses that our law enforcement agencies have suffered, as I view them all as friends and colleagues. I relive in my mind my own patients that I could not save-law enforcement and civilian alike.

And I also fear for my husband. I fear that one day he will get pulled over, and won’t come home to me. We have got to start listening to one another, trying to view this situation from a perspective other than our own, and most of all…

The Shooting Has to Stop.

I am the proud mother of 2 boys, who are biracial. My 4 year old looooves police cars. Recently we were in Chicago, and these amazing CPD officers (thank you!) happily engaged my child who was so excited to see their vehicle. They invited him to not only sit in the car, but to turn on the lights. My son still, over a month later, talks about this day.

It breaks my heart that if things don’t change dramatically in our country, that I will one day have to tell him some things that will change his love for those flashing lights.

Although I have never posted any personal pictures on this page before, and certainly not of my children, I am going to change that today, for a reason. I want to leave all of us with some hope, an image of innocence…

The image of a little boy in love with a police car.

To my friends and colleagues in Dallas, to the victims and their families- my thoughts and prayers are with you.

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I had a familiar conversation the other day with yet another female medical student.

“I really loved surgery!” she said, “but I was concerned about the lifestyle so I decided on _______________.”

Lifestyle, it turns out, almost always seems to be code for having a family (maybe it’s just the kind of students who are apt to seek me out as I have yet to encounter someone who is concerned that a surgical career will hamper their aspirations to compete in triathlons or become national fencing champions or write books for the general masses–I personally know surgeons who manage to work full time and do all of these).

The other day, I came across yet anther discussion board on what advice to give to women in search of “mommy friendly” medical specialties. There were lots and lots of suggestions, some were full time jobs with predictable hours and others were part-time jobs but not one of the suggestions was a surgical subspecialty.

Not. A. Single. One.

Sigh. This makes me sad for my chosen specialty and for all the promising young women who will not go on to realize their potential as amazing surgeons.

I would be lying if I said that surgery is lifestyle friendly. In fact, anyone who has followed this blog for more than a millisecond knows that many of our daily woes outside of work arise from the demanding hours and high stress of our career choice. But the question is: What does mommy friendly even mean? This is not the same as the “mother’s hours” often noted as selling points in help wanted ads. There may be ways to go really part-time or certain very specific specialties that enable a woman to only have to be at work when her kids are at school I suppose. But I have to believe that mommy friendly is about more than just the hours.

I know, I know. You are just waiting for me to launch into the cliche of it’s quality, not quantity. But I won’t.

Because the truth is I wrote all the words above nearly 500 days ago. It turns out I never finished because I don’t know what mommy friendly means when it’s used as an adjective for a career.

Since I first wrote the beginning of this blog post, I have spent well over a year of my life as a surgeon and a mother. I even wrote an open letter to young women with the same opening line evidently having forgotten about this draft. That letter, now read more than 15 thousand times, doesn’t define mommy friendly either.

To be sure any work place can provide these but do the amenities in and of themselves mean the associated profession is mommy friendly? Not if the backhanded comments or outright displays of resent persist. Often, the culture of the profession is at odds with these progressive work place policies. And these replies on what medical career to choose clearly indicate that the culture of medicine has not caught up to modern times.

Luckily, however, not every one is reading the same message board. And so this week across the country a whole new crop of women begin training as surgeons. They are less a minority and more just reflective of the demographic of modern surgery. Hopefully, they will all become surgeons (there is still some attrition in our programs nationally) and some will become mothers. And my hope is that, together with the men they are training with, they will foster a culture in which is it no longer necessary to ask if surgery is a mommy friendly.

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I am on call today. It’s been an average day for this trauma surgeon. 1250 miles away, it has been a day of extraordinary carnage at a trauma center in Orlando, and that was for the 53 people who survived the incident. Another 50 were left dead at the scene, all shot by a single person.

Yes, a single gunman.

This tragedy brought up a lot of issues that torment and divide us Americans today.

Anti-gay bigotry.

Islamophobia.

Gun control.

No doubt the perpetrator was a horrible, soul-less person. While whether he was driven by hatred for gays or misappropriation of Islam or an obsession with ISIL are issues worth considering, the fact of the matter is that, regardless of what drove him to do this, his impact would have been far less severe if he had not been in possession of an AR-15 semi-automatic rifle.

In the hours since news of the horrific event emerged, several friends shared a clip of President Obama on the PBS Newshour responding to a query on gun control where he discusses how the reduction of automobile-related mortality was data driven and how we are hamstrung by the NRA and those who are backed by the NRA when it comes to finding data-driven solutions to the gun problem. The President assured his audience that no one is going to take away guns from “lawful, responsible gun owners [who use them] for sporting, hunting, protecting yourself.” In fact, it appears that Moms Demand Action (an organization that emerged after the Sandy Hook tragedy) used data to change its focus from a ban on assault weapons to a focus on background checks and common sense use of firearms. Evidently, the data showed that the 1994 assault weapon ban, which existed for a decade before it was allowed to expire in 2004, did not save that many lives, and the organization wants its efforts to save as many lives as possible.

But let me ask you this:

Did the lives of the 50 people killed and 52 wounded in the Pulse night club not matter?

Did the lives of the 26 people killed and the 2 wounded in Sandyhook Elementary School not matter?

Did the lives of the 12 people killed and 70 wounded inside the Century 16 Theater not matter?

In his PBS town hall, the President also commented on restrictions on background checks which some believe may have prevented this man in Orlando from becoming a gunman. Many people posted the list of the 45 senators who blocked legislation that would have kept someone on a terror watch list, a person of concern to the FBI, from getting any gun legally. However, when there is not a legal way, someone truly intent on killing will find an illegal way. An so this single person who killed so many instantly in such rapid succession would have found a way.

He might have built as bomb as we saw in Oklahoma City and at the Boston Marathon. But, fertilizer, diesel fuel, pressure cookers, and ball bearings have other purposes.

He might have flown a plane into the building as was done in a calculated, multi-person, multi-year scheme set up by a worldwide terror group on 9/11/2001. But planes are intended for transport.

I could go on and on. And I often hear these myriad ways that others can kill cited when people state “Guns don’t kill; People kill.” Heck, I see them daily in my job: beer bottles, baseball bats, ice picks, kitchen knives, pipes, motorized vehicles…These all can be used to commit murder but are nowhere near as efficient as a semi-automatic rifle.

And for these reasons, yes it is worth discussing what motivated this man to commit mass murder. It’s worth trying to understand how he became this venomous monster. It’s worth examining our processes of surveillance by law enforcement of those whom we suspect might become venomous monsters. But come on, do we really need to amass any quantity of data on semi-automatic rifles? A single magazine can hold 20 to 100 rounds of military grade bullets and fire up to 60 times a minute. Do we need really need study if this kind of weapon is necessary for decent law-abiding folks to shoot tin cans in their back yards, or take down deer for sport, or protect themselves from home intruders?

Don’t get me wrong. I am both a surgeon and a health services researcher. I thrive on studying vexing issues through data collection and robust statistical analysis. I believe evidence-based approaches. Like many trauma surgeons and injury prevention researchers, I too want to know if biometric locks would reduce accidental deaths due to handguns. I wonder what psychometric tools might be used to optimize background checks if we ever could effectively implement them. I just don’t think we need data on this particular kind of weapon.

In case you missed it before, the kind of weapon that was used to kill 50 people nearly instantly and injure 52 more in Orlando overnight, was also used to killed 12 and wound 70 in Aurora, CO and was used to kill 20 children and 6 adults while injuring 2 more in Newtown, CT.

I was recently attended a talk by Dr. Lenworth Jacobs, a renowned surgeon at Hartford Hospital. He spoke of what steps they took on the day of the Sandy Hook massacre to ready their trauma center. Alas, no one was transported there because the vast majority were dead at the scene. Dr. Jacobs had the difficult task of reviewing every single autopsy while preparing a consensus statement on how to handle active shooter events. The air went cold as he described to a room full of surgeons what the military grade ammunition did to those poor kids’ bodies. They never had a chance.

The Hartford Consensus statements that would emerge from this review of Sandy Hook and other mass shooting focused on how to prepare civilians, first responders, and trauma centers to save as many lives as possible in the face of such horrific events. Nothing was said about the weapons themselves. When asked about this, the Dr. Jacobs responded that it’s too politically charged; and since active shooter events will presumably continue to happen, our role [as surgeons] was to identify a problem that is addressable (people dying of possibly preventable hemorrhage) and address it (education on hemorrhage control within the context of active shooter events). The logical person in me who understands that the right to bear arms in part of the fabric of US society admired the pragmatism and ingenuity regarding active shooter events described in Dr. Jacob’s talk.

Less than 3 weeks later there was the deadliest ever active shooter event in Orlando. To be sure, some of the 53 who lived must have benefited from the data reviewed for the Hartford statements. But please don’t tell me that you need data or that data is the reason why you won’t stand up and say “no, not ever” to a type of gun that can rip holes in the aorta, pierce through the brain, pummel through the heart, and break strong bones into bits and pieces in an instant up to 60 fucking shots a minute. There is no need for civilians to ever have this kind of a weapon. Not ever.

And while it’s true that people will continue to die because those intent on killing will do so with criminally acquired firearms or by weaponizing everyday objects, because law-abiding gun owners will continue to be careless with their hunting rifles and handguns, and because those suffering from depression will commit suicide by firearm, we simply cannot stand behind this veil of data in not calling for a ban on semi-automatic assault rifles.

The overall number of people killed by the AR-15 and similar military grade firearms might pale in comparison to the aggregate numbers of lives lost through other forms of gun violence but lets not devalue the lives of those killed and injured with these heinously destructive weapons by pretending we need data to ban them.

We don’t need data. We need to stand up and do the right thing. We need to put an end to the ‘single shooter able to kill multiple victims in just a few minutes’ phenomenon made possible by the deadly combination of soul-less perpetrators and powerful semi-automatic assault rifles.

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Since this post was first shared a number of people have posted petitions regarding a ban on assault rifles. I don’t know what if any impact any of these will have but I am sharing them below.

Imagine you are the paramedic at this scene. Who do you take to the hospital first? Who do you have to choose to walk past and leave at the scene while you take your patient to the hospital?

Now imagine you are the surgeon. You walk into an emergency room with blood everywhere – covering faces, limbs, the floors. There is a cacophony of sound – screams, cries, gasps, whimpers. Where do you start? Which room and which patient gets your attention first? How many patients, calling out to you for help, do you have to pass by? What operation will you perform and how will you perform it knowing there are nearly 50 other patients needing your attention at that very same moment? Will you be right? Will you save everyone you could?

As a trauma surgeon, these are the real types of questions that we are given when training for mass casualty situations. And although the patient specifics listed above are not from the shooting, these are still the same thoughts that every single healthcare worker and all six trauma surgeons in Orlando right now have had and will continue to have for months to come.

26 operations in 12 hours. I wish I could adequately describe the inhuman and superhuman effort that this represents from the trauma surgeons at Orlando Health, one of whom has been a friend of mine since high school. When I first heard the news I immediately contacted him, letting him know I was thinking of him and his team, knowing exactly that this day will never leave him, or any of them. I have written before describing the multitude of feelings involved when losing a patient… but this is just the tip of the iceberg when discussing a situation of this magnitude.

After the adrenaline surge, after the floors are mopped, the scrubs are changed, and the patients sorted through, they will pick apart this day – every last detail, decision, and action will be analyzed, examined, and questioned – and never forgotten by a single person who touched a patient on June 12th, 2016.

These six trauma surgeons have made a thousand decisions in the past 24 hours – the types of decisions that no one should ever have to make, but are unfortunately faced more and more by those of us in this field.

To the surgeons at Orlando Health – I know you haven’t slept. I know you haven’t eaten. I know you haven’t sat down in close to 30 hours. I know you are mad, I know you are sad. Stay strong my friends, we are all with you.

My thoughts and prayers go out to the victims, their families, the first responders and healthcare workers in Orlando – #lovewins.

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My heart sank when I heard the news that a local police officer had been killed in the line of duty. I was not on call that day but I knew exactly what the words “he was taken to a local hospital where he was later pronounced dead” meant. As trauma surgeons we provide care for those injured in senseless, often preventable ways daily. But when an officer is stricken it hurts in so deeply because we share a position with them at the forefront of the worst that happens in our society.

So when I heard the news I mourned for the officer, for his family, for his colleagues, for all of law enforcement, and for the people who tried so valiantly to save his life and would forever be asking themselves “was there something else we could have done?”

Let me assure you, there was not.

As with all trauma centers, we have a comprehensive morning report where we discuss all of our new patients: what was the mechanism, how did they present, what was done for the work-up and subsequent treatment? So it was clear that the trauma team did everything they scientifically or physiologically could in this case. In morbidity and mortality* terms, this would be a ‘non-preventable’ death.

Here’s the thing though, of course it was preventable. And we are all (as members of the community, as his brothers and sisters in law enforcement, as representatives of both sides of the criminal justice system, as providers in the healthcare system) asking this same question “why, why did a good man—a good cop, a good husband, a good father, a good son, a good citizen—die this way?”

Clarity notwithstanding, there has seemingly been a shift in public rhetoric questioning of infallibility of those on the front lines of law enforcement. Sadly, in some cases the rhetoric has escalated to vitriol, rioting, and even directed acts of violence against law enforcement. It truly is maddening that a man, fueled by the overarching discourse questioning police intentions and behavior, would then seek an opportunity to kill the police as in the case of Mr. Ismaaiyl Brinsley who gunned down Officers Wenjian Liu and Rafael Ramos of the NYPD, not during the act of apprehension or while committing another crime, but just because.

However, no matter what the headlines are, the overwhelming majority of our men and women in blue are good men and women who take on their duties with the best of intentions and model professional behavior. And so, when this good man’s mother cites this volatile discourse as a possible cause of his death—as much as my heart breaks for her—it hurts our community by suggesting a local conflict where there was none.

By all accounts, the cop killer in this case was a sociopath lacking any respect for human life or the laws of our society in general as evident by a lengthy record replete with charges ranging from cocaine trafficking, to assault & battery, to weapons possession. Those of us who are not career criminals might get tachycardic or diaphoretic during traffic stops but our natural instinct is to reach for our license & registration, not for our gun. A man with no moral compass felt cornered and so he fired; but, this was no more because he was cornered by an officer than if I had made some gesture to this armed and dangerous criminal during my nightly dog walk.

So, while a family, a profession, and a community mourn, I urge each of us to contemplate how the criminal justice system might have functioned differently to prevent this senseless tragedy but to avoid stoking fired up rhetoric that pits people against the police and police against the people. Discourse that drives us apart stands in the way of viable solutions to combat the socioeconomic and psychological factors that may drive one to a lifetime of crime in the first place and to take those who cannot be rehabilitated off the streets before another preventable death, be it of an ordinary citizen or a man/woman in blue.

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*Morbidity & Mortality, or M&M as it is called is a weekly conference held by surgical teams to review all deaths and complications in an effort to learn more about the systems-based and disease-based processes that led to the adverse outcome.

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The obstruction had resolved. The nasogastric tube was out. If the diet advanced as expected he could be discharged to continue his chemotherapy. He was not even my primary patient. He was on the heme-onc service so I wasn’t even responsible for the paperwork.

Yes, he was dying of cancer. That was not news to him. Nor was the nausea and vomiting that he had come to expect in the wake of periodic infusions of poison. That which was intended to kill the cancer cells also killed a little bit of his insides with every dose. But the distention and obstipation was new. He had not felt right 4 days ago and he had rightfully come to the ER.

His diagnosis was small bowel obstruction. However, one could not tell from the CT scan if it was due to adhesions from his cancer surgery some years ago or due to new tumors scattered in his pelvis which had in recent months made him the unfortunate bearer of the “stage 4 cancer” moniker. As if the side effects of chemo for his cancer recurrence were not enough, now he had to suffer through this. But he was better by the time I met him as the new attending on a consulting service.

My exam confirmed the residents’ optimism that the obstruction had resolved. It was likely adhesions given the swift improvement and I noted how the nasogastric tube works to relieve such obstructions to the patient and his wife. But I explained that we were not sure, based on the original CT scan, if the cancer was playing a role in impeding the flow of GI contents. Either way, as long as he was able to tolerate oral feeds he could resume his cancer treatment with the hopes that the same symptoms would not recur. He did not need an operation in the immediate future. The patient and his wife were relieved.

As I concluded my visit, I asked (as I always do) if there were any other questions.

“No,” replied the patient’s wife. “But thank you so much. In all our time here, no one has explained what was really happening. Thanks for making it so clear. We really appreciate it.”

But seriously, I was at least the 4th attending physician to meet the patient not to mention the countless 1st through 6th post-graduate year trainees who had cared for the patient before I met him. Yet no one had taken the few minutes it would take to explain why the patient felt so miserable and how an uncomfortable tube down his nose might help.

Understanding the disease process is pathophysiology 101. Explaining it to the patient is doctoring 101. Sure, doctoring 201 is the art of explaining it in a way that caters to a patient’s educational and verbal capacity without instilling fear; but that no one had even tried just made me sad as a physician and as an educator. Once again, I took solace in the fact that there was a resident with me to both observe the explanation and to witness the words of gratitude. Hopefully, that’s my way of paying it forward just a little bit.

So at the risk of sounding too preachy let me leave you with this: If you take care of patients, remember they and those who love them are humans in a state of crisis. Amidst the pain, the fear, and the uncertainty of what’s to come, taking a moment to offer an explanation for the suffering can go so much further than any medication or procedure. Consider it the #1 tool in your physician’s toolkit.

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The tension between the desire to provide the best care and the system putting up road blocks was building the entire day. As the surgeon advocating for my patient, it felt like the smoldering rapidly progressed to full on conflagration. And yet, the patient and his family were calm and full of grace.

On morning rounds, I told my patient that his hernia remained reduced but there was an area along the bowel that had been stuck the prior evening that looked worrisome on CT scan. His vitals, exam, and blood work were reassuring, I explained. There was no imminent rush, no immediate threat to bowel or life. However, it made sense to get this done as soon as possible. The patient, and his wife at the bedside, understood. I had explained a clear set of options for what to do about the hernia depending on a) how the bowel looked when we put the cameras in and b) based on my understanding of his baseline co-morbidities. He was a smoker with a chronic cough that exacerbated his hernia. I spent a little bit of time counseling him that this might be an ideal time to quit. Anything to ameliorate the cough during the recovery process and beyond would reduce the chance of recurrence.

Those words “as soon as possible” resonated in my head as the wait for OR time dragged on all day. Circumstances were at a systems level well beyond my control; the absence of an immediate life threat meant I had no real leverage other than rants about patient satisfaction and costs of prolonged length of stay. This meant nothing given that there were patients who truly needed life or limb saving interventions, including one of my own who arrived at 5pm with free air.

This patient was too stable.

I had run up to his bedside a few times during the day with updates to the effect of “not sure yet…but you continue to look good…as soon as possible” He and his family–thankfully–were remarkably affable while I was becoming more and more agitated at the OR inefficiency in between urgent cases.

[I could write a dissertation on OR efficiency, or lack of it. And, certainly this is not a problem limited to my workplace. But that’s not what this blog is about.]

I was not on call that night. The OR could finally accommodate the case in the late evening. It went as well as could have been expected. The bowel looked great. The patient got the best case scenario of the options I had presented to him some 16 hours previously.

When I went to talk to the patient’s wife afterward in the waiting area it was almost midnight. She was exhausted from a day of anticipation. From two hours of anxiously waiting while her husband was in the OR. She gave me a giant hug and thanked me so profusely for sticking by him. “I know you have been here since so early this morning,” she said. In the moment of that most genuine embrace, the fire went out and the frustration of the day slipped away.

The next day, in preparation for discharge, the patient was exuberant. “You’re a miracle worker doc!” he exclaimed. “I’m done with the butts now. Forever. Thanks to you. And you fixed my hernia. You’re a miracle worker.”

It took me a while to figure it out since it’s been forever since someone referred to cigarettes as butts to me. The miracle was not that I fixed the hernia. It was that for the first time in 50 years he was motivated to quit smoking. His wife would stop too, she told me that day.

It was a tough day at work but this lovely couple thought I was a miracle worker deserving of a hug despite it all. No anger. No bitterness. Just genuine gratitude, a case that went textbook well, and some preventative medicine to boot. What more could a beleaguered surgeon ask for?

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Bed A is the ‘door’ bed. My patient was in Bed B, the ‘window’ bed. I had just met him; it was a new inpatient consult. For all the rules and regulations surrounding patient confidentiality, the curtains between beds do little to protect privacy since inevitably there will be audible conversations about symptoms, diagnosis, and management between patients and the doctors, nurses, or family who visit them.

…

The residents had already seen the patient in Bed B and were reviewing his case in detail with me between OR cases. I looked at my watch, contemplated typical OR turnover time for a moment, and decided we had enough time to get the consult done.

When I got to Bed B, I introduced myself to the patient and sat at the edge of his bed. I explained that I had already reviewed his story, lab data, and imaging and confirmed these facts. I stood briefly to perform my physical exam before beginning to scrawl on an index card. I simplistically portrayed the complex anatomic relationships between the liver, the gallbladder, and the pancreas and the series of tubes (the biliary tree) that connect these organs. I described how stones form when the balance of three ingredients (bile salts, lecithin, and cholesterol) in the viscous fluid (bile) made by the liver, and stored in the gallbladder, gets off kilter and how those stones can then cause blockages at various points along that biliary tree. I showed the patient where his problem was and used hash marks to explain the operation and what would be removed.

Before getting my patient’s signature on the consent form, I made sure any questions were answered and asked if he wanted me to call a family member to summarize the details. He said no and signed.

Conversations like this take time. Whether it is the 4 patients per 15 minute block in clinic or the patient who I am rushing to see between OR cases, I invariably feel pressed for time when talking to patients. But I do what I have to do, often skipping meals or holding in bodily functions while incorporating a brisk walking speed to keep up with competing demands, none of which seem to incentivize having thoughtful and thorough conversations with patients and/or their families.

After telling the patient in Bed B that I would see him in the pre-op holding area the following day, I upped my walking pace so I could run back down to the OR to my next patient. I had already taken too long and was anticipating the reprimand of the OR board. And that’s when I heard the patient in Bed A.

…

“Hey Doc!”

“Ugh” I thought to myself, “I really don’t have the time to find this guy’s nurse for his pain meds or to figure out how to keep his IV from beeping…”

But how could I not stop? He was addressing me directly so I paused and turned to him from the threshold to the room.

“Hey Doc! It ain’t none of my business or anything but I just wanted to say that there would be a lot less fear in healthcare if all doctors explained things the way you do.”

I was humbled by this man’s feedback. I hoped my residents were listening, both to the man in Bed A and to what had just transpired before Bed B.

I find it very irritating when students or residents peel away or talk among themselves, as if they are sick of hearing what I have to say, while I am having conversations with our patients. To me, modeling doctor-patient communication is my greatest gift to them as a teacher and a mentor. I want them to listen, to observe, to understand that every encounter is a chance to learn.

As we hustled back to the OR, I turned to the residents and proudly said “For as much pride as we surgeons take in doing the perfect operation or nailing a difficult diagnosis, what happened back there might have been the highlight of my career.”

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It was lovely to meet you the other day. Many times a month, a young woman just like you comes to me with similar interests and concerns. “I really love surgery,” she says, ” But I am afraid of the lifestyle and I really want to have a family.”

Oh, and thank you for also inviting me to speak at your seminar the other day on Women in Traditionally Male Dominated Fields. I have been speaking at similar panel sessions since 2005 when I was a bit of a novelty at my training program as a clinical PGY-4 with an infant daughter. Your collective curiosity on what my life must be like is of great interest to me because to me it’s just my life. It’s the only reality that I know because, like you, I was young (just a few days into my 25th year, just 5 days into my first ever surgical rotation) when it occurred to me that I really loved surgery. It was unexpected; but every day since then (from the remainder of that MS3 rotation, to my sub-internships, to my years in residency, to research and clinical fellowships, and to these past 6 years on staff) I have crafted a reality, as tenuous as it is, that works for me and my family in any given moment in time.

And I am here to tell you that you can do the same too if you, in your heart of hearts, can think of nothing more exciting than surgery as your professional passion.

People outside of surgery will tell you that it’s a career that is too hard to integrate with family life. They are correct that it is generally harder than other fields in medicine; but, ask yourself if you truly want a career in general pediatrics, or dermatology, or invasive cardiology or anything in between. If the answer for whatever alternate field(s) you are considering is no, then no matter how many fewer hours your profession requires, no matter how much more flexible those hours may be, your family will be left with a present, well-rested, yet bitter wife and mother.

[NB: I use the word integrate very purposefully here. Anyone from a demanding profession, surgery or otherwise, who tells you that work-life balance is possible is conning you. Your life will never be in balance. Something will always have to give: your work, your family, or yourself. It’s in how you integrate these things in a shifting, fluid professional and personal lifetime that you will craft your own reality.]

The same can be said of those who encourage you to enter surgery training but then offer that you may consider a career in breast surgery or start an exclusive vein clinic or choose some other presumably less time sensitive and/or less time consuming surgical practice to balance your professional work with your desire to have a family. Again, ask yourself if you can truly be happy in such a practice. (I personally would be bored with only a few kinds of procedures in my armamentarium and the absence of physiologic chaos; but everyone is different.) You may not know the answer until you are well into your training; but, choosing a medical specialty in the first place, or a surgical subspecialty in the second, simply because you presume it will be easier for family life is fraught with potential for professional dissatisfaction. I promise you that professional dissatisfaction will always stand in the way of overall family life satisfaction. Always. Forever.

Finally, as hard as it might be to envision yourself as a surgeon who wants hobbies, and a spouse, and a smoking hot body, and children of your own someday, remind yourself that divorced parents, widowed parents, disabled parents, parents with deployed military spouses, and parents with far fewer socio-economic resources than practicing surgeons, and trainees for that matter, somehow get it done. Every life has it’s particular challenges when it comes to parenting but surely being a surgeon is not the most insurmountable of them all.

So think long and hard about alternatives to surgery; but choose one only if it speaks to your professional soul. No matter what career you choose, you will likely spend more time at work than on any other aspect of your life be it parenting, self-care, love-making, you name it. Therefore, it is critically important that your choice of career light the fire in your belly to show up every day leaving behind, at least temporarily, everything else including your children. Because one thing is for sure: when you are practicing surgery, your head needs to be in the game. You cannot be distracted by guilt about not being with your family or about delegating some of the more mundane aspects of childrearing or homemaking to others. You must love the work enough to drop the guilt and create practical solutions to raise your children and provide them with a safe and loving space in which to grow while reimagining whatever stereotypes you hold about being the perfect parent.

Because you know what: There is no such thing as a perfect parent, surgeon or otherwise. So there will never be any point in beating yourself up about it. Know that you will love your children more than you could have ever imagined loving anything, including surgery, but that you will still be a great surgeon. The two are not incompatible, but it takes some effort and creativity.

So, now that I have convinced you to choose the career of your dreams here are some thoughts on the effort and creativity it will require.

Do not underestimate the importance of choosing a life partner who gets the soul inspiring nature of your career choice. He/She may be another surgeon, or physician in another specialty, or a non-medical professional, or a skilled laborer; it doesn’t matter as long as your life partner understands that, when you are tired from the long days and nights, or sorrowful for the lost lives, or otherwise distracted, it is not because you love work more than you love them. Bottom line: as awesome as any career may be there is something messed up about your priorities if you really would choose work over loved ones. So your life partner needs to get that you aren’t messed up; you just have a demanding career.

With the demands of that career comes the need for a real partnership in planning life. That doesn’t mean a 50:50 split or a 80:20 split or anything conscribed; it means a constant openness to splitting however it needs to be split or not splitting at all to ensure that life outside of work happens. It means making the most of precious few waking moments together through physical contact and communication. It means having a very user friendly calendar/shared to-do system. It means providing feedback without judgment for the practical things in life and making space for shared emotional and spiritual needs. If you find yourself paired up with someone who can’t work with you on life this way, then consider dumping him/her. Seriously, it’s not worth trying to make them happy if they just don’t get this hugely important part of what makes you whole.

[NB: If a life partner is not your thing or things just don’t work out, that’s okay. The same principles of reimagining, outsourcing, and dropping the guilt apply. It’s just that your village, or metropolis as may be the case for some surgeons, has a different population structure.]

Choose your job based on both professional and personal needs. Training is finite and there is always an end from which to take on a new direction. However, even though many surgeons change jobs, think of your job as your forever job so you don’t accept a situation which will turn out to be toxic for you. Choose partners who will have your back, and you, in turn need to be willing to have theirs. Choose geography that at least satisfies some of your desires for commute time, distance from extended family, lifestyle, weather, etc. and makes life easier. You can’t blame surgery if your long commute destroys your soul, or if having your parents thousands of miles away makes you sad, or if humidity, piles of snow, or whatever your most dreaded weather phenomenon is drives you crazy, or if it takes a flight to get to your favorite past time of hiking, biking, skiing, etc. That’s on you and the choices you have made as a surgeon and not on the profession itself. Finally, choose a practice type and setting that will make you excited to show up every day (for me it was research, teaching, and a level 1 trauma center in a university based system).

If you do have a life partner and working is important to him/her, don’t pick a location that will railroad his/her career. As much as being a surgeon defines you, your soul mate is similarly defined. Please don’t create a situation where he/she will be susceptible to resentment about having his/her professional goals squashed. (I’ve been there. It puts a real strain on a marriage. It sucks.) It’s already hard enough to be paired up with you, a surgeon. Both your jobs may be equally demanding, or one may be more demanding; it doesn’t matter as long as together you negotiate a mutually satisfying life-long give and take about who prioritizes what and when depending on the stages of your respective careers and the ever evolving needs of your family.

When is comes to family, do not waste too much mental effort over-thinking when you should start it. Fertility, along with finding the right person with whom to test your fertility, is a complex and unpredictable thing. No pregnancy is guaranteed to proceed smoothly. Given these inherent limitations and unknowns, along with the demands of a surgical career, there is no perfect time to start a family. This is about as certain as death and taxes. I will spare you the perceived pros and cons to having children during training compared to while in practice. Just know that every time period poses challenges and every passing year makes infertility more likely; so if you are ready in your personal life to try to get pregnant go for it; because, if you choose to wait for a perfect time, you will be waiting for a very, very long time.

And, if having children in a traditional sense is not possible for whatever reason, there is also no perfect time for assisted reproduction, adoption, or surrogacy either even though the salary increase a staff surgeon or faculty job may be necessary for these options. In the end, whatever approach to becoming a parent will be required, you will figure out a way to get through the challenges because you will have mentally and emotionally committed yourself to the idea of being a mother who also happens to be a surgeon.

[NB: If you choose to not have children-by this I really mean choose as there are myriad other mishaps of life and physiology that prevent women who want to be mothers from becoming mothers-, please do not make that choice simply because you want to succeed as a surgeon. You will never forgive yourself. Not ever.]

When it comes to family there are various options to manage childrearing and homemaking. A nanny, two nannies, an au pair, daycare, a nearby grandparent, a neighbor who is a stay-at-home parent, or various combinations of these may be required to keep your children loved and safe. It’s different for every family and I promise you that you will find what works for you. It will be a source of stress but it is doable. And, no matter how much time others spend rearing your children on your behalf, those kids somehow know that your are their mother, that you love them in a way beyond any other love, that you would give your own life if it would save them, and that you also happen to be a busy surgeon. Trust me. They will. And, they will be really proud of the uniqueness of their surgeon mom. They really will.

When it comes to your home, be it your 600 sqft rental in residency or your 2500 sqft grown up home in a cul de sac, outsource any jobs you and/or your partner simply do not enjoy. I cannot emphasize this enough. You will, in fact, have precious little time with your family. Ask yourself how you want to spend that time. Do you want to being cleaning and doing laundry? Or do you want to plan a family outing? If hopping on your John Deere and showing your lawn whose boss on your Saturday off is a fun activity for you, then by all means go for it, otherwise someone else will be happy to mow your lawn for a fee. If you love cooking, knock yourself out planning, shopping for, and preparing gourmet meals along with the associated clean up, but if you don’t then find a meal service. You get the point. If you don’t love it and it can be done by someone else outsource it. Even on a trainee’s budget you should strive to rid yourself of any household obligations you abhor. (For me the $55 spent every other week during residency for cleaning was well worth never having to spend a day off cleaning a toilet and now the extra hours we pay our nanny to do all of our laundry has spared me a monthly power weekend of washing and folding 10 loads of laundry because we just could not get to it all with the many kids’ activities, call nights, etc. that prevent daily washing.)

Remember: as little time as you will have at home to spend with family, you must also prioritize time for yourself. Don’t expect it to just happen. Just as you schedule elective OR cases, you must schedule elective you time. It may not happen very often but if you don’t take the time for self care in the midst of the stresses of the job and the stresses of parenting you will be cranky and miserable to be around. How you spend time away from family when you have so little time with them will change over time and you may even develop hobbies incorporating your family (we have taken to family bike rides and kayaking trips as the kids have gotten older to combine wellness with family time) but remember to schedule things that feel completely selfish to you. A girls’ night, date night, a pedicure, reading a trashy novel, going to a Zumba class during bath/bedtime, or whatever you enjoy is totally not selfish but you will feel that way; so a good barometer for whether or not you are making time for self care is how selfish it feels. My advice is feel selfish at least once a month.

[NB: If your selfish thing is not a fitness thing then you have to also figure out how to fit that in because your patients and your family need you to be healthy.]

Being a surgeon is not incompatible with being a good wife, mother, athlete, whatever else; it’s just trickier. But, if young women keep being scared away from surgical careers then these same fears will linger generation after generation; we will never achieve a critical mass of women surgeons in the profession who can set good examples for one another and for future surgeons. With the same focus we apply in the OR and the same organization we bring to rounds and the same compassion we bring to patient encounters, we can create a life strategy that overcomes these perceived barriers for both a happy family life and a successful surgical career. The barriers will change depending on the stage of the career you love so much and the needs, wants, and development of what and who you love outside of work; but, take it from this surgeon mom: they are barriers to be overcome, not shied away from.

I am pretty sure that’s why you showed up at my door and asked me to that seminar, to make what seems impossible to you at the moment seem possible. Let me tell you: if I can do it, you can too. Go forth, be a surgeon, be a wife, be a mom, be good to yourself and craft a reality that works for you. Then, pay it forward so that someday these meetings and seminars might be rendered obsolete.

PS. Here is some inspiration. Your potential in surgery is limitless. https://www.womensurgeons.org/in-practice/leaders-in-surgery/

PPS. The Association of Women Surgeons is an invaluable professional organization whose goal is to: ENGAGE current and future women surgeons to realize their professional and personal goals. EMPOWER women to succeed. EXCEL in those aspirations through mentorship, education and a networking community that promotes their contributions and achievements as students, surgeons and leaders. https://www.womensurgeons.org/

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I have been waiting for a moment of joy in the profession that did not involve death to write again. It turns out that those moments are few and far between and I feel compelled to write a few words today. Writing, sharing, letting out the feelings I must keep at bay when I am with my patients and their families is therapeutic.

Bearing witness to physical pain and emotional suffering is part of the job. The opportunity to ameliorate the body’s failure and to transcend the soul’s response are part of the allure of the work of surgeons, in particular trauma surgeons like myself. A good day at work for me–a day when I get to flex my life saving muscle and bask in the glory of my critical care prowess–is a bad day for anyone on the receiving end of my clinical skills and empathy, no matter what the outcome.

No one wakes up expecting to be at the center of a human tragedy. Yet, as trauma surgeons we are thrust into a peripheral role in such tragedies daily. In my typical week on service (a few nights on call, 7 days of rounding, two clinics, and reams of accumulating paperwork) the balance of patients with minor injuries, good outcomes, or major life saves typically outweigh those with severe life-threatening injuries at risk of high morbidity and mortality. But this has been an atypical week.

These last 6 days have been filled with inexplicable events and unimaginable losses for my patients and their families. Car crashes, suicide, house fires, occupational hazards, animal attacks, physical abuse, interpersonal violence. The causes have been varied. The effects have been a river of tears flowing through a mountain of grief. The landscape of sorrow created by these tragedies has exhausted me far more than the overnights and the ~110 hours logged in the effort to provide round the clock trauma care.

As surgeons, we hope not to grow too used to it, not to become cold and unfeeling in the face of human tragedy. But we need some way to move on. This week, I feel buoyed by gratitude of surviving family members and the supportive words from fellow providers. The warm embrace and patience of those who love me and care for me during those few hours away from work have also helped. But with one more day to go, I am simply wishing for a quiet last day on service devoid of human tragedy. No more bravado in the trauma bay. No more delivering bad news. No more grief for the people in my catchment area. We all need a break.

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Guilt was not a huge part of my vocabulary until I became a mom. (Well, if you take out my feelings about my occasional twinkie binge.) Anyways, I never felt much guilt about how I spent my time. Didn’t feel guilty about sleeping in… or working out… or having a girls’ night out. And so on and so forth.

And then I became a mom. You know, that moment when you get shoved into the most beautiful world – a place more beautiful than you could ever imagine… and then the door to your prior world gets slammed shut and padlocked behind you 😉

To be exact, I became a trauma surgeon mom. A mom that can work in a week and a half what most Americans might work in a month. I work crazy hours, am tired almost every single day, and typically I get only one weekend off a month. Nope, no pity party here. I chose it and I love it. But, as I mentioned in the recent Forbes article, try as I might, I just can’t seem to find more than 24 hours in a day. So what all this means is that it often requires pretty creative scheduling to keep my sanity. Occasionally I try to arrange my schedule for a random day off, to take my kid to the zoo. Or I might delay responding to some emails so I can go work out.

However, when I started this creative scheduling is when the guilt started creeping in… becoming a part of my mental vocabulary. If I were running, I was thinking about all the work tasks I still needed to accomplish. If I was at the zoo, I was worried about what my partners would think about my random Monday off. If I was at work even when I really didn’t need to be, I felt like my family was, yet again, getting the short end of the stick.

The workouts stopped being enjoyable, my zoo time was colored by frequent email checking, and I just couldn’t totally relax and be in the moment, in any moment. And that, my friends, is when it finally sank in… how my guilt was directly leading to my burnout. In order to actually relax, restore, and repair myself, I need to be truly present and mindful. Guilt will not let me be truly present or mindful, and I had to get rid of the guilt.

The moment you start feeling guilty about taking time to regenerate, is the moment that time stops regenerating you.

In fact, I was doubly screwing myself. On paper, I was taking the time to exercise, or take my son to the zoo, or read a book. However, I was not practicing mindfulness, or allowing myself to truly be present in those moments, allowing my mind and soul to relax, let go, and restore themselves. Those thoughts of – well I could be doing this, or maybe I should be doing that – instead of fully focusing on whatever activity I was actually doing was completely counterproductive.

Let me ask you a question.

Have you ever felt guilty about brushing your teeth?

Okay, so why not? Probably because you feel it is a necessity, something you have to do – to stay healthy and keep people from hating to be around you. Well, why not try giving your restorative time the same respect? And although I have heard more than one person tell me that “mom guilt” is a fact of life, an absolute, something to just accept, I am calling bull$hit. Although feelings in of themselves are not necessarily a choice, we choose how we react to and acknowledge those feelings. Once you fully understand and acknowledge that restorative time is important, you won’t be able to feel guilty about it. Unless you feel guilty about the time it takes you to brush your teeth. If that is the case, I really can’t help you… other than I know some great dentists.

So, my challenge for you today, heading into the weekend.

Give your soul the same respect you do your teeth.

Accept that you need TIME to participate in activities that make you whole.

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To her it was like any other day. She had dropped him off, as was their usual routine, and gone into the city to see a friend.

He was an experienced member of the ski team. Practice was familiar. Take the lift up, ski down. Take the life up, slalom down. Take the life up…

It all happened quickly. He slipped through rail of the lift. The impact on the cold, hard packed snow was devastatingly complete. Perhaps it was his head, or maybe his spine, but vital functions were cut off immediately; he went into cardiac arrest. The ski patrol started CPR. Someone alerted dad. He arrived almost as quickly as the paramedics. They intubated him with efficiency and continues advanced cardiac life support.

He arrived as my patient immobilized with a long spine board and a cervical collar. He was intubated and CPR was ongoing. He had lost vitals signs at least 20 minutes ago. Dad was by his side as he rolled into the trauma bay. We kept coding him for the next 45 minutes. His pupils were blown. His skull base was boggy. We knew it was futile but he was someone’s child. It was hard to let go. But we did.

When I told dad, he was alone. He had not grasped the magnitude of on-going CPR and was utterly shocked when I told him his son was dead. My lip was quivering as I delivered the crushing news; my tears followed soon after he began to sob.

He asked me to call his wife. I told her it was serious and to arrive quickly but safely. Her grief is something that I will forever hold with me. I cried with her too. And, though it was not the first, nor would it be the last, time, that I would cry with a family experiencing sudden loss, my ability to be with these parents–REALLY BE WITH THEM–at the darkest moment of their lives reminded me, somewhat paradoxically, of the joys of my profession.

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We had a lovely still “cool” looking Yukon Denali to which I just had to say “goodbye”. Why is it my husband’s fault you ask? He’s 6’6″. And, well, because we found out last week that a car seat will not absolutely, positively, in any way, shape, or form, fit in a seat behind my husband while he is driving. This would then relegate my three year old to the third row meaning someone (me) would be required to gracefully (insert eye rolling emoticon here) climb back to the third row every. single. time. to buckle him in and out of said car seat. Oh and yeah, say goodbye to any cargo space for anything other than an umbrella stroller.

Fast forward to two days ago, when my husband walks into the minivan dealership and loudly proclaims,”This must be what a dog feels like on his way in to get fixed. You guys got accessories? I mean, if we are going down, we are going to go down fighting! Chrome wheels? No? How about 22’s?”.

For real, peeps. This happened. So, we are now the semi-proud owners of a new Honda minivan. But in keeping with the chrome 22’s theme, I have set the Ode to my Odyssey to the tune of that ever classic, ever catchy tune, Snoop Dog’s “Gin and Juice”.

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He had loved her with all his being for more than 6 decades. In the last 2 years of their 61 year marriage, he had watched helplessly as dementia wrapped its noose around her, slowly tightening its grip on her mind and pulling her away from him.

When I met him I knew the injury was irrecoverable. Her brain was consumed by hemorrhage that had filled the space (cerebral atrophy) left behind by progressive dementia and then some, deflecting the midline between the two hemispheres nearly 12mm.

I asked him what had happened. She had tripped and fallen. For all her mind’s frailty, her body was still strong and agile for her 83 years; how she stumbled in the small living room they had shared for more than 50 years remained a mystery.

She was still breathing on her own but her brainstem’s ability to preserve this vital function was succumbing quickly to the pressure building from above. She appeared to be peacefully sleeping. He had not yet grasped that she would not be waking up.

I asked him what life was like at home before today. She was no longer aware of who, what, when, where, and how. A nurse would come daily to help her bathe and dress. She would then spend most of her day in a trusty old recliner. He would cook and feed her, then put her to bed every evening. They had no children. They had outlived their siblings.

Theirs was a story of two lifelong friends and lovers. Every Sunday he would take her for a drive. He wanted her to see the sun and the trees and the world outside their home. This was romance in the denouement of life. And here I was, suddenly a supporting character in the final chapter of their love story.

He cried quietly as I explained the magnitude of the injury. Like too many of my octogenarian patients, she had no advanced directives. None of the providers who knew her far better than I had thought a discussion of code status was worthy it seems. So this was my role.

We talked for a long while. After reviewing what all the technology in my critical care armamentarium might do and not do for the love of his life he said to me, “I don’t know I what will do without her. I don’t know any other life. I don’t have anyone else.”

His heartache was palpable.

There was surprise and some expression of dismay at the administrative hassle I caused when I planned to send her home with hospice services directly from the ER that day. I am grateful for the ER physicians, nurses, and social workers who helped me execute that plan even though it would have been far more convenient for us to simply admit her to the floor.

That she would die peacefully in her home of five decades with her partner of six by her side is the kind of medical outcome that looks poor on paper but feels good to the surgeon’s soul.

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Long time followers of this blog know that we started it based upon a shared quest to be better to ourselves, our bodies, our families in the midst of very demanding careers as trauma surgeons. As the one who started the blog, I must admit that my initial intention was to focus on what made us whole outside of work. And so, much of the content, especially early on, was about our shared interests in hot heels and all things fashion, our efforts to stay healthy donning our cool kicks or our ballet socks, and our challenges as wives and mothers whose day jobs require a scalpel.

But as time passed, we wrote more and more about our professional experiences, because it turns out a large part of our whole is what we go through at work. After all, with 4-10 nights per month on in-house call and standard 120 hour weeks on service in addition to research, service and society work to advance our academic careers, we spend many, many more hours on the work part of ourselves than the outside of work part of ourselves.

Since my hope had been to share the outside of work part of ourselves in this blog, as I found myself writing here more and more about work related issues, I recently created separate blog. I told @surgeoninkicks it would be my “professional blog” where I could share some of the darker stuff that affects us (i.e., someone interested in my Jimmy Choos may not want to be confronted by the sorrow that I feel when I lose a patient). It would be a blog where I would write about the experiences that help me maintain joy in the profession.

However, the reality is that the two sides of our worlds are not separable. Maintaining joy in the profession in inextricably linked to finding joy outside of work. @surgeoninkicks understood this but it took me longer to confront this reality of who I am.

I am a surgeon in a specialty with extraordinarily high rates of burnout, with hours that pose significant logistical challenges to self care, family life, and extracurricular activities, and with routine exposure to human pain and suffering. I do feel joy in doing my best to care for patients and their families. I did choose a career path where I would be balancing non-clinical and clinical work. I do have a husband, two children, a dog, many friends, and interests outside of work. I do feel stress in juggling it all and routinely engage in retail therapy as an elixir. I am not nearly as fit and healthy as I want to be. This is who I am.

So, this week I will migrate the few posts from my other blog into this venue. I will continue to write about all the facets of who I am in this blog, a blog I am so lucky to have shared with a true soul mate in @surgeoninkicks. She has seen me through this crisis of online identities and I am ready to share completely. Thank you for the continued readership. Your enthusiastic support of our work is greatly appreciated.

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I walked through the double doors of the Trauma ICU just like any other morning. But that particular morning, instead of being met by my favorite nurse or a fellow resident, I was met by two men wearing balaclavas and carrying assault rifles.

This was the first time I realized that maybe I wasn’t safe at work. I was a second year surgical resident. Chicago was in the middle of yet another gang war. We were treating patients that had been involved in this urban warfare, and “credible threats” had been made not only against those patients, but also against the hospital. The men in the balaclavas were part of Chicago PD, and they had our entire trauma unit surrounded – to keep us safe. And for that, I am greatly appreciative to this very day.

But that is when it hit me, why does the supposedly safest place, a place where healing occurs, need assault rifles to keep it and its workers safe?

This morning I am met with yet another story of a doctor being murdered at work. My heart goes out to his family, his coworkers, and New Orleans. As a medical community we are again brought together – not to celebrate a stunning breakthrough in the treatment of a disease, or a patient success story – but to mourn.

According to the Occupational Health and Safety Administration (OSHA), the vast majority of workplace assaults occur in a healthcare setting. In response, hospitals are locking doors. Installing metal detectors. Hiring security. And allowing those guarding its doors to carry guns. Is this the right answer? I don’t know. What I do know, is that regardless of political affiliation, regardless of race or socioeconomic status or religious beliefs, we have to come together and at the very least, return our safest places in America, our havens from the outside world – schools, hospitals, and places of worship, back to safety.

So, you can imagine my abject disgust when I heard about, and then read, this post from Kevin MD – “5 tips for parenting a future surgeon”. Feel free to read it, or I will be glad to summarize it here. This was written by an anonymous mother of a surgeon who states, “Mamas don’t let your babies grow up to be surgeons” and then proceeds to list all the horrors of allowing or encouraging your child to become a surgeon. Let me list them for you here.

Anonymous mother – you should be downright ashamed of yourself. And let me clearly, and as plainly as possible, tell you why.

Doctors, and surgeons in particular are a national shortage. Sure, the world existed before surgeons, and the world would exist without surgeons. But, I don’t think I’m out on a limb here by saying that we save and improve lives daily. For example, think of the over quarter of a million people every year who need to have their appendix taken out. Most people think of appendicitis as a fairly benign or mild disease. However, without a surgeon, and even with antibiotics, a significant proportion of those patients would suffer and potentially die. This doesn’t even begin to address the other whole host of diseases that we treat and even help cure – breast cancer, colon cancer, gallbladder problems, heart disease, bowel obstructions, and traumatic injuries. Fact of the matter is, without surgeons, life expectancy would quickly and expediently drop. But hey, feel free to go around encouraging people not to go into a profession in which the only goal is to help other people.

Yep, medical school costs money. And yes, the vast majority of us need loans to pay for the education. But last time I checked, universities, and community colleges, and trade schools also cost money. And a lot of people also need loans to pay. Should no one pursue any sort of education that costs money unless they can pay for it in cash? That seems just slightly elitist from my perspective.

Hmm – okay. Well let’s keep going. So, should no mother allow their child to join the military? I have a hard time believing that someone could make it through any sort of military training much less SEAL or Ranger training without getting yelled at… or cursed at… or sleep deprived for periods of time.

And lady, you want to know why?! Because what they do, and what we do, is serious. And some might even say stressful. Like, you know, life or death kind of stressful. Handing out trophies is NOT going to prepare someone for those types of situations.

I am not excusing abusive behavior. What I would like to ask is what kind of training do you want your surgeon to have? Being told they are right when they are wrong? Not learning to perform under some semblance of pressure? Because let me tell you how that will end up – with you on an operating room table and an incredibly unprepared surgeon looking down at you. Good luck with you on that… let me know how it turns out for you.

Just for the record, my parents are kinda proud of me. They think the fact that there are people living today, waking up and going to work, kissing their loved ones goodbye because of me, is pretty cool. But hey, if you think your child not getting yelled at is more important than that… well, I have heard it “takes all kinds”.

My real advice to you? Go find a surgeon, and hug them. Because they chose to go through years and years of rigorous training all to help you. And although there may not be a real trophy at the end, keeping people alive seems to be reward enough for most of us.

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My heart tells me I lost them. My brain tells me I never had them to lose.

One of my mentors has said that all trauma surgeons have their own personal graveyard, filled with patients we couldn’t save, and families’ hearts left broken. A truer statement has never been said, and this weekend, this trauma surgeon’s graveyard has increased yet again.

The feelings that accompany this increase are always varying and deep.

There is anger. True wrath. When the hell are we going to figure this out? When are we going to stop shooting one another?! When are we going to learn that drinking and driving can be deadly?! When are we going to start respecting ourselves, our bodies, and one another?! When are people going to stop paving a path of destruction for themselves and others that is wide and immeasurable?!

There is sadness. Sadness over the pain and the fear that my patients surely felt. Sadness over the waste of life that we witness. Sadness for the families left behind, in a new world they never anticipated.

And yes, guilt. Guilt over being able to go home, when our patient couldn’t. Guilt for leaving the hospital to enjoy my family knowing another family has just been destroyed.

This weekend was a particularly rough one for myself, and the hospital at which I work. Although to most people around the country, it was just another act of violence, to myself and our community, it was felt deeply. Every person in our hospital was stung, upset, and shocked. Everyone knew what happened – I received touches on the arm, knowing hugs, and reassuring smiles. They knew I did everything humanly possible even when the inhuman was needed, but that knowledge is a poor salve against this type of wound.

So please, if you know someone who works in healthcare – give them a hug, a high five, or even a thank you. I have said before how we all take you, our patients and communities, home with us at night, but please also know that our lives are never the same either. Every patient encounter alters us – sometimes subtly, and sometimes drastically. We are changed, and we never forget.

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Burnout, burnout, burnout. It seems like that is all anyone wants to talk about these days. And I admit, some days, I can get burnt out on burnout. But, all the attention on the subject got me thinking… did burnout not exist 30 years ago? Why is this such a hot topic now?

And that is what brings me to this post – I came to the realization that burnout very much existed 30 years ago, but that the current “write-up” culture, and what I affectionately refer to as the “Twitter effect”, that is now prevalent in healthcare and most US hospitals has made it infinitely worse.

Let’s face it. Surgeons have a reputation – bossy, mean, rude, impersonal, hard to work with, and difficult. And, this reputation, just like Rome, wasn’t built in a day. It wasn’t even that long ago (during my training years) that surgeons would throw instruments, throw nurses, medical students, even anesthesiologists out of their operating rooms, or yell, scream, and curse to their heart’s content. Infidelity and extramarital affairs were rampant, paperwork wouldn’t be completed on time, and bad outcomes only had to be discussed at a weekly Morbidity and Mortality (M&M) conference and only with other surgical colleagues.

Clearly, most of the above described behavior is unprofessional, inappropriate, and unacceptable. But, what it did do was provide a mechanism, a valve so to speak, with which to vent anger, frustration, sadness and fatigue. And, for a very long time this behavior was viewed as a fact of life. Nurses would talk amongst themselves, junior residents would get stuck having to operate frequently with the most malignant personalities, clerks and environmental services staff would just look the other way.

But then, over time, we became enlightened. We became proactive in empowering any and every one to speak up against unprofessional behavior, sexual harassment, or profane language. We began to focus more and more on ways to measure performance. How long does it take for a physician to complete their paperwork? How many patients are you seeing in a day compared to your peers? Hospital complications are now labeled as “never” events. M&M’s have become Disney World vacations when compared to having to re-live bad outcomes over and over again in hospital-run root cause analyses and peer review sessions to examine the role of the physician in bad outcomes.

But somewhere in all this enlightenment, we have lost the true message of healthcare.

Healthcare is about relationships, not write-ups.

We have now cultured a culture in which having a bad day, losing one’s patience, or not smiling enough can now lead to getting “written up” by anyone in the hospital – student, resident, nurse, clerk, patient, etc. The filling out of paperwork, and the careful coding of certain physical conditions so as not to get dinged by the hospital for providing “suboptimal” care, are now fodder for write ups. Physicians are held captive and measured by the electronic medical record, NSQIP, 360 degree evaluations, and quality metrics.

So what does being written up mean exactly? It means meetings (often multiple) to discuss said incident or incidents, papers being placed in personnel files, and sometimes poor job evaluations. I call this the “Twitter effect” – anyone can say anything at all about you, true or false, whether you have worked somewhere for 15 years or 15 minutes… and it gets attention.

Don’t get me wrong here. Professional behavior should be expected at work, and we should always strive to be better physicians, nurses, healthcare workers and humans tomorrow than we are today.

But, punitive attitudes and actions are NOT going to result in any of that. I have never written anyone up in 11 years, and I pride myself on that because it does not change behavior.

Bottom line, if someone is an a**hole, writing them up is not going to change that. And, if someone just had a bad day, or is having a rough week, having a relationship with them, being able to engage them in a conversation, will change their future behavior. A piece of paper will not. Most times, people already know when they messed up, giving it undue amounts of attention only lead to feelings of defensiveness and self-doubt. And the truth of the matter is bad days happen to all of us.

I am human. Am I at my best after 36 hours of call inside the hospital with 60 patients on service, back to back emergency surgeries and emotional discussions with families about poor outcomes for their loved ones? Absolutely not. But am I still expected to smile, teach residents, make the medical students feel comfortable, get daily paperwork done within 24 hours, have the patience of Gandhi and not make any errors in clinical judgement? You better believe it. And, for the most part, I’m 100% okay with that. I signed up to be a surgeon, I didn’t draw it out of a hat. However, the feeling of walking on eggshells, the inability to have a bad day, lose one’s patience, or be anything other than perfect is soul-crushing.

I feel this especially as a trauma surgeon. Surgeons in general are at a national shortage, and especially so with trauma surgeons. Most institutions are not running fully staffed, leading to more call nights, longer hours, and more fatigue. And no, this isn’t subjective. Being a trauma surgeon and the amount of call a physician takes have both been directly associated with the development of burnout.

Gone are the days where a surgeon can throw an instrument or curse out an entire operating room… and good riddance, quite frankly. But also gone are the days in which anyone can have a bad day, get frustrated, or maybe say the wrong thing, and have it understood or handled without a paper trail. The relationships we form at work are meaning less and less, and paperwork is meaning more and more. And, until we change this – until we change the punitive and negative culture within healthcare – we will continue talking about, and becoming, burned out.

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Two years ago today, I wrote my first blog post. It was on running a half marathon in my hometown. It was my third half marathon. Writing about the experience and it’s reflection on my past was a great way to start blogging, something I had been contemplating for at least a year by that point. You see, my zeal to run was borne from following the musings of others who felt similarly challenged with regards to their personal wellness.

And so, Hot Heels, Cool Kicks, & a Scalpel came to be. It’s a blog about what a traumamama does to get through the days and still be whole–a whole surgeon to her patients and their families, a whole researcher to the university and funding agencies, a whole teacher to her trainees and students, a whole peer to her colleagues, a whole friend, a whole sibling, a whole daughter, a whole spouse, a whole parent, a whole person who takes care of herself.

I was lucky to have hoodwinked my fabulously witty and sarcastic fellow traumamama @surgeoninkicks into this whole blogging thing soon after this first post. Our original connection was that we were both trying to make running part of our lives at a time when life and work was overwhelming and causing us to neglect ourselves. I had no idea how compelling her writing would be but I knew I needed to do this with her lacking the time to keep the content flowing on my own. Working on the blog together (it’s our form of joint therapy) has help our friendship grow in ways that I don’t think either of us imagined and we have also run together on many an occasion since then.

Finding time to run is still the hardest thing I do and running is my biggest physical challenge. Since my first real run without stopping at a whopping 15min/mi pace in August 2011, I have logged just about 1100 outdoor miles (and very few on treadmills). But I consistently run at an 11-11:45 pace these days (depending on hills and whether or not I have done a recent barre class!) and have finished 4 half marathons and a Ragnar Relay just this past year alone. Four days ago I ran that same hometown half marathon again. It was my third time. I posted this photo at the corrals with the caption “Suck it high school self-esteem issues.” It was a hit with my Facebook friends. (PS. if you hit Old Navy’s clearance rack in the summer you will have lots of $5 throw away fleece that comes in handy when the temperature at the start line is 29F)

With the 2 year anniversary of this blog, I want to say a continued suck it to self-neglect and thank you for continuing to read the random, somewhat disjointed, musings of two traumamamas who engage daily in the push and pull between their families, their patients, and their own well-being (fueled through food, fashion, fitness, humor, and sentimentality). Together we have written 195 blogs that have been viewed more than 1.2 million times and we now have 787 followers.

I hope you will continue to read, and subscribe, and share and I will continue trying to run as much as a I can.

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Hey Carpool Mom! Yeah, that’s right I am talking to you in your Yukon XL SUV.

Even though your vehicle is the size of a bus, it is not, in fact, a school bus. Therefore, stopping in the middle of a busy road to load a dozen boys into your vehicle is a really bad idea. You have no flashing stop sign jutting out on your driver’s side so there’s nothing to keep oncoming rush hour traffic from bowling into the boys who clearly have not been taught to look both ways before crossing the street. Or, perhaps your random stoppage in the middle of the road led them to believe that they too could put aside any regard for their personal safety in the rush to leave practice.

Way to role model Carpool Mom! Your friendly local trauma surgeon suggests that you consider pulling over at a safe location, with your signal on, and have the boys look both ways and use the cross walk before piling into your SUV. Unless of course, you are trying to cut down on the volume of boys you must drive around by encouraging brain injury, internal bleeding, long bone fractures and the like because, well, that is a strategy I suppose for the exasperated Carpool Mom.

How many seats does that behemoth have anyway? Does it come equipped with seat belts as most modern American vehicles do? Because by my count, even with that extra row of seats in your giant SUV, there were 2 too many boys in the passenger area of your car. So I guess it’s no surprise that not a single one of them made any effort to put on a seat belt after piling into your vehicle. I suppose that goes hand in hand with the street crossing technique you and your, ummm, safety consciousness have inspired in these boys. Oh, and I bet you are thinking I should not frown upon the two who piled into the cargo area for not putting on seat belts because, well, there are no seat belts for the cargo area.

So again, your friendly local trauma surgeon would like to gently remind you that seatbelts save lives. Oh, and it’s the law in our state to have those boys in restraints. Also, there’s a reason it’s a cargo area and not a passenger area: boys are NOT cargo. If your ginormous vehicle is still too small to handle the entire team, why don’t you consider asking another parent to help with the carpool? Surely there is someone else willing to share the Carpool Mom of the Year Title.

Because clearly your nonchalant wave back at me as you pulled away indicated that you relish that title. However, it seems to me that you are undeserving of the title since you are seemingly oblivious to the risk you have exposed these boys to with your carpooling technique. You were lucky that oncoming traffic stopped and let the boys barrel across the street just feet from a crosswalk without bothering to look both ways. And, if you stop short during the remainder of your journey, two boys will be flying out of the lift gate window. If you cut a turn too sharply through the center of town, bodies will be careening into each other and the metal cage you have tossed them in without proper restraints. Or, if you get rear-ended, at least one of them will strike his head on the back of your seat and you might be trading in your damaged SUV for a wheelchair van.

As your friendly local trauma surgeon who has held in her hands the brain matter of boys struck by automobiles while haphazardly crossing the street and has had to deliver the sad news that a boy will never walk again due to lack of being restrained in a vehicle that crashed, I hope that you, Carpool Mom, are prepared to live with your grief and the grief of the other parents, when your “I’m indestructible” attitude gets a harsh reality check.

Here’s the SUV in question. Vehicle details have been anonymized to protect the guilty.

Each year, 1,600 motor vehicle passengers under age 15 die while nearly 130,000 more are injured in car crashes in the United States; and, nearly 300 more die while another 10,000 are injured when they are struck by vehicles. More than half of the children killed in car crashes are unrestrained. Proper restraint use reduces motor vehicle related morbidity and mortality by more than 50%. Furthermore, jaywalking and lack of attention to oncoming traffic are the culprit in well over 50% of adolescent pedestrian vs. auto deaths. Today, Carpool Mom, you encouraged those boys in your care–entrusted to you by their parents–to jaywalk and they most certainly did not look both ways before getting into your over-filled vehicle that you then put into motion without having the boys properly restrained.

So next time you are in charge of carpool, ask yourself, “how would the other parents feel if I had a party and served alcohol to their sons?” Because today you might as well have gotten those boys shit faced drunk with the example you set for them and the risk you exposed them to. I was not on call to accept incoming injured patients this afternoon, but I sure hope everyone got home safely.

If my profession as a trauma surgeon has taught me nothing else, it has taught me this.

“Life happens to everyone,” and unfortunately, a lot of “life” isn’t pleasant. Car accidents, strokes, heart attacks, broken legs, and ill family members are just a few examples of life situations that happen to everyone, whether or not you have a uterus. And guess what they all have in common? A need for time off of work.

Now, the distinct disadvantage here is that women usually need a set block of time off for maternity leave that seems relatively long (to some, at least) and at an age where they are usually young and healthy, but let me tell you gentlemen, people are going to be covering for YOU when your prostates need to come out and your coronary artery needs a stent. No, you may not need 12 weeks all at once, but, between doctor’s appointments, procedures, recovery, and complications, or at some other point in time in your life, you are going to need significant time off of work, with your partners/coworkers/etc. chipping in and helping out. And, oftentimes without the 6 month’s notice that your pregnant colleague is able to give. And guess what else? That is OKAY. That is what life is about – building relationships and working in teams to get the job done, even if someone is having a bad day, a stroke, or a baby.

Oh, and just as an FYI, let’s just say you break your leg while skiing and you need at least 6 weeks off of work… I don’t think people will judge you and say that went skiing and break your leg – accidents happen. So being judgmental and saying that every woman chooses to get pregnant is pretty inane. You chose to go skiing, she chose to have sex. Get over it.

Maternity leave = family leave. (Or, hopefully will equal family leave at some point soon in the future.)

I have to admit, I was blown away by the responses I received on our blog, through FaceBook, Twitter, and even my own personal email from my last post. Women from all walks of life shared their stories, and overall, as Americans, and as humans, we should both be encouraged and appalled. Some female physicians wrote how supportive their partners were, but as a group, would have to sneak around HR to get her time off. Some women went back to work in less than one week to preserve their family’s income and sometimes their job. Office administrators refusing to allow 15 minutes breaks for new moms to pump breastmilk. A new mom, forced to use a surrogate, being allowed zero time off because she wasn’t actually birthing the baby herself. The stories unfortunately go on and on.

Yet, the stories of finding support from male coworkers was encouraging. And, I do think most men and women without children also, absolutely see the value in family leave – whether it is paternity, maternity, sick leave for themselves or to care for an ailing family member. Bottom line, every single one of us is going to need time off of work, expected or unexpected, and we are all are going to have to rely on each other, and a system to help us out. Unfortunately, for most of us, that system does not yet exist… and at the end of the day, we can do this better – for ourselves, and each other.

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Netflix listens to doctors. Google, Facebook, and Apple listens to doctors. The United States Navy and Marine Corps listen.

The above “companies” have updated their maternity leave policies – lengthening them all past 12 weeks… and all paid.

But yet, healthcare doesn’t listen to doctors. And let me tell you how.

I am pregnant. Which is a blessing in of itself. In fact, this is my 4th pregnancy, but I only have one child living. So really, this is an absolute blessing that I have had a healthy pregnancy so far. I should be over the moon excited. Yet, there has been a black cloud over my heart since I first saw the “yes” on the pregnancy test.

Currently, I am the sole income for our family while my husband is in law school. And yet, my job does not provide fully paid maternity leave. The thoughts and stress of how we are going to balance our financial needs with my family’s emotional need for me to spend that precious, once in a lifetime time at home with our new son has left me downright drained.

I am currently in “discussions” with my large academic health physicians group as to how much paid leave I will actually receive for maternity leave. And let me tell you, their initial response was significantly less than 12 weeks. I think for me, the most disheartening part of these “discussions” with my employers is that they keep asking themselves, “Well, what have we done in the past?” instead of, “What should we be doing?” Despite the fact that I will need a repeat cesarean section. Despite the fact that due to short staffing over the past 3 years, I have given up 8 weeks of vacation and worked extended hours for years – including in-house calls up to 62 hours in a row. Yep, folks, you read that correctly. I have literally come in to this hospital on a Friday, and not left until a Monday morning. And I have done it, because that is what the job required, what my hospital needed. Trauma surgeons are a national shortage, and my profession often calls for dedication above and beyond the imaginable.

I always felt like that dedication was well placed – for my patients, for my hospital, for my community. And that this dedication was shared by healthcare in general. However, I feel that maternity leave is an issue that highlights my belief that for many institutions and practices, healthcare has lost its focus. Healthcare should be about caring for people – our patients and each other. Healthcare should be setting the standard for how other companies handle maternity leave – yet we are amongst the worst hypocrites.

After all, we are the ones recommending that women exclusively breast feed for a year – yet practice administrators dictate whether or not physicians can build 15 minute pumping breaks into their schedules. We recommend women not return to work for 8 weeks after a cesarean section, yet we don’t pay them. Several studies have shown that women who return to work before 12 weeks have children with more behavioral problems in early childhood, yet, if she doesn’t come back by 12 weeks, we take away her job. We know that depression is directly linked to a lack of time off after the delivery of a baby, yet we continue to point to the letter of the law and say that what we offer is enough. I wish these examples and studies weren’t real, but they are.

The dollars and cents seem to matter more for those that employ physicians than the health of their physicians. The disparity of how maternity leave is handled amongst physicians here in the United States is downright shocking. Some institutions automatically grant 12 weeks paid, but these unfortunately are in the minority. Most pregnant physicians are in a similar situation to me, and are left to fight, scramble, and scrap together time off after delivery and even time to pump when we do return to work.

And the kicker of it is, the physicians are usually the worst hit by these policies. If I were a nurse, or an hourly employee, I would be able to roll over or accrue my vacation days. Other employees could even donate paid time off to me. I would be mandated lunch and work breaks so I could pump. I would never be left wondering how I could safely store breast milk for up to three calendar days. But yet none of these options are typically available to physicians.

I wish this were one of my usually snarky, humorous, Gomerblog worthy posts, but it isn’t. Unfortunately, I am writing today from a place of hurt, a place of feeling abandoned by my own profession – the people that are supposed to care about my health the most, seem to care about it the least.

Interestingly, academic practice, trauma sub-specialty, increased nights of call, longer hours worked, younger age, female gender, and small children at home were all risk factors for burnout. For those of you who are new to this blog, I am a female academic trauma surgeon who routinely works long hours and takes in-house call while my small children are at home.

To be clear, these data prove associations and associations do not equal causation; but still, it is sobering to think that so many who entered a profession to fundamentally improve the lives of others are themselves leading such troubled lives due to their chosen occupation.

The occupational hazards of surgical careers are multiple. We suffer moral distress when our patients experience complications or die whether or not an error occurred. We develop compassion fatigue by bearing witness to our patients’ collective and continuous suffering no matter how successful any individual’s outcome may be. Due to our long and often erratic hours, we suffer from chronic fatigue and sleep deprivation. The physical plight caused by fatigue is complicated by many hours on our feet and maintaining awkward postures in the operating room. By routinely putting our patients before ourselves, we often exhibit illness presenteeism. Not infreqeuently, we face the double bind of choosing between being there for our patients or being there for our family. Meanwhile, whether it’s catching up with billing and coding one day, keeping up with meaningful use another day, or spending days studying subjects totally irrelevant to one’s daily practice for maintenance of certification, delivering care in the modern error mandates many a frustrating task that ultimately does nothing to benefit our patients. Furthermore, there is constant fear of litigation that might ruin us in financially or reputationally. And so, it is not surprising that so many of us are burned out.

Emotional awareness (how are you feeling, how does what you are feeling impact your behavior, and how does what you are feeling impact those around you)

All is not dark, however. There are ways for us to be well and resilient. They require both individual effort and culture change. Importantly, they demand emotional awareness. When we understand how we are feeling impacts both our perceptions and our actions, we can act in a way that props us up rather than gets us down.

I was heartened this past week that the American College of Surgeons chose to put surgeon wellness and resiliency on equal footing with the likes of “what’s new in hernia repair” or “ethical challenges in geriatric surgery.” There were a number of educational panel sessions tackling burnout head on. Whether is was about bouncing back in the face of personal loss, gender discrimination, pathways to help surgeons recovering from alcohol abuse back into clinical practice, or managing fatigue, the program was replete with informative sessions on burnout avoidance. Mindfulness, time management, kinship, and down time were emphasized as was physical fitness.

And for the first time ever, the College had a fitness program. As that youngish female academic trauma surgeon with two kids who has struggled with tending to herself after spending her youth, college, medical school, residency, fellowship training, and early years on faculty essentially ignoring personal wellness, I was delighted that this change was happening at my profession’s annual meeting. It was something of a pilot test offering only a very early morning Zumba and a Yoga class, but it was a start. Sure many surgeons at this meeting probably went to the hotel gym or hit the lakefront running path but these efforts happened without the largest surgical professional organization’s imprimatur (hey I even got an American College of Surgeons yoga mat!) or beckoning. These surgeons are likely the 6 in 10 of us who aren’t burned out. But that doesn’t mean we should ignore the self-neglect of our brothers and sisters in the occupation. So this simple step of organizing these fitness events indicated to all attendees that the College both encourages and supports surgeons taking care of themselves. Embed from Getty Images

Making time for fitness has been shown to reduce burnout so I hope the College expands their offerings this time next year. I invite the College to challenge us surgeons to find time for wellness within the already overwhelming conference that offers 5 days of educational sessions geared at making us better surgeons technically and intellectually. The annual Clinical Congress of the American College of Surgeons has essentially had this format the entire time that I have been attending (every year for the past 12 years). With the pilot fitness program the College chose hours and days specifically to not interfere with this typical format. However, given that all the data shows that prioritizing wellness is a key factor in combatting burnout and that wellness takes on many forms, the College should offer multiple offerings–whether it is meditation, or high intensity interval training, or barre, or a knitting circle, or Zumba, or TRX, kick boxing, or spinning, or running– at different times throughout the conference thereby forcing us to prioritize just as I was forced to prioritize between “surgical jeopardy” and “what’s new in body contouring.”

It will be hard for us to make these choices but we need the practice. I figure its easier to choose wellness when there are no cases to be done or patients waiting in the ER or clinics to be staffed, when there are no lives at risk other than our own.

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I can relate. You have made it to middle age (Gasp! Yes it is true, we are more than half way to 80) and you have spent a quarter of that lifetime (Yes, the past twenty years! My god, have we really known each other that long?!) neglecting yourself.

I get it. You were busy training for a lifetime of work in one of the most demanding careers around. You trained and you studied and then you trained and you studied more (Do you really have three degrees after college?!? Was being valedictorian of your elite college not over-achievement enough for you?!) Alas, none of that training was of the “personal trainer” or “training for an Ironman” kind. No. You didn’t have time for that (Okay, neither did I; yes, I confess that’s my office wall).

I know why. There were the 120 hour work weeks, then there were the babies, and now there is life with a busy career and growing kids (They really have to have sooooooo many needs! Darn food and shelter! But, why so many school events? And for the love of god, why so many extracurriculars that eat up every weekend that we are lucky enough to be off?) I know there is a spouse involved (I mean how else would those kids get clothed and fed everyday while you work from dusk to dawn, or frequently from dawn to dawn or dawn to the dusk 40 hours later?). In the midst of all this working and raising babies you are busy doing your best to be a good wife too.

So I can totally see why putting you on the bottom of the list was easy. You would feel too guilty to do to otherwise (You know that guilt trip is totally in your head, right? Everyone around you, who you feel you don’t give enough time to, would really rather you put some time into yourself.) You deserve it. You need it. It will make you a better wife, a better mother, and a better doctor. But it needs to be something that gives you pure joy so you don’t beat yourself up about not writing that grant instead, or missing bedtime, or skipping that after dinner glass of wine with your husband. I too used to struggle choosing it on the precious few nights I home from work and not in a post-call coma. But I am so glad I found it.

And, I am writing to tell you that it is Zumba. You see, I remember the days when if it was a Friday night you were spritzing on the Aquanet and heading to Sh-booms to dance the night away (In retrospect both the hairspray and the venue was questionable but you were young). I have a vivid picture in my mind of you rockin’ out to It’s Raining Men at your wedding (Why you would be delirious about it raining men having just married the man of your dreams is also somewhat questionable but it is a great song). And, I know your childhood dream was to become a Solid Gold Dancer (Okay, in retrospect the hairspray and the venue totally make sense even though it was no longer the 80s by then!)

I love Zumba and so will you (Zumba’s motto is “ditch the workout, join the party.” Doesn’t everyone want to party more as they age and trick the body into feeling younger, hipper, and cooler?). Zumba burns calories and builds core strength through super fun dance moves. Many are Latin inspired but there is a range so you can salsa, or charleston, or plain old old-school aerobics style grapevine your way to an effective workout (Come on. Surely you have seen the infomercial? Yes, it’s true you really do have that much fun doing Zumba. Not everyone there is as hot as on the infomercial but that’s fake TV and not real life). There are some variations like Zumba toning that focus more on muscle definition (In Zumba toning you use a double sided maraca thingy and who doesn’t love that–like shaking a martini without the alcohol and calories but the dancing leaves you buzzed in a calorie deficit.) Also, as if channeling your childhood aspirations there are cool Retro 80s Zumba parties (Seriously, if this isn’t s sign what is?!?). You can see how the Core Connection‘s clients danced “Like a Maniac” here.

So instead of trying to coordinate our schedules to meet up over a cosmo let shake at Zumba together. You love to dance; getting a groove on is in your biologic makeup (I know because I am a doctor) so I guarantee that Zumba will bring the pure joy that it seems you need to justify being able to find some way to squeeze physical fitness into your life in a way that reading journal articles on a recumbent bike decidedly cannot.

It may be the answer to your mid-life fitness woes my dear, dear friend and former aspiring Solid Gold Dancer.

Love,

Your ungraceful, uncoordinated, booty does not dissociate from her spine but still gets her ass to Zumba friend,

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It’s been a busy week back to work after Ragnar Cape Cod so I have been a bit delayed in my promised glut of #Bragnar posts. Find a recap of my actual legs here. More than a week after Ragnar Eve, I am still giddy from what a great experience I had. Here’s why.

1) The views

I haven’t run any other Ragnar Relay races before but this particular one came with some killer views.

2) Letting out your inner kid out

Evidently it’s a thing to decorate vans for the race. Doing this as an adult tends to make one giddy.

3) Speaking of acting like a kid

Again, sticking magnets on vans is a bit of silliness that we tend not to manifest in our grown-up lives and some of the team names were hysterical.

4) The crazy night gear

Overnight runs call for gear that will make you stand out in the dark and I love things that sparkle and glow!

5) The other crazy gear

Typical road races have water stations ever couple of miles or offer little other the backs (if you’re as slow as me) of other runs to view but we supplied our own water and got to take a movie over the Bourne Bridge.

6) People acting crazy

Let’s face it, being up all night in a hot sweaty van in between running a lot will lead to some insanity. Who doesn’t love some insane behavior among friends. (Okay, it was mostly just this one chick who was crazy but I love her!)

7) The cheering

I loved people rooting for me and I love rooting for them.

8) Sharing the starts and the finishes

In most races, you run from start to finish but in a relay you get to hand off to your buddies at each exchange and this camaraderie is special.

9) The friendships

Even if you find yourself in a van full of strangers, it doesn’t take long to get to know each other really, really well.

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Before I go onto to multiple posts about the bonding and the beast mode and the best trail mix ever, I will simply recap my role in this relay race with all the bells and whistles of my Nike Running App, Fitbit Charge HR, and Ragnar materials along with a fashion play by play brought to you by my obsession with Athleta.

For those who don’t know, the Ragnar Relay Series is a series of overnight relay races in cool places across the country where teams of 6-12 runners run various legs from one point to another covering about 200 miles in about 2 days. Historically, the non-running teammates follow along in a rented van that also doubles as a hotel room for most teams. With a few half marathons under my belt since I ran for the first time in 2011 (2 miles at 14+min/mile), I thought it was time to mix it up. So when a Facebook friend asked for a couple of more teammates for her Ragnar Cape Cod Relay team I was intrigued and felt up to the challenge.

My husband and I essentially joined a team of strangers, hence our not-so-original team name “Never Get in a Van with Strangers,” nicknamed #StrangersInAVan for race weekend social media shenanigans.

We all met for the first time about about three months before race weekend. We picked our legs based on known abilities and desire. With a 12 person team, we were each destined to run 3 legs each. I was in van#2, runner#9. I was scheduled to run a 3.2 mile easy run, a 5.6 mile hard run, and a 7.3 mile very hard run. I was concerned by the incremental increase in difficulty as time passed but the ninth spot was a good fit for me with other spots being better for others in my van.

Strangers In a Van: Van#2

A few days prior to race weekend, my final leg was increased to 9 miles. Ugh. With just 7 on the docket, I hadn’t run more than 6 miles since the Disney Half Marathon in January. But, it was what it was and I was in. All in. And so it began. My first ever relay race.

I ran in my Athleta Be Free Knickers and a mesh run top from last season. As with all the runs to follow I ran in my Newton Fates, RoadID sneaker pouch, Asics Kayano running socks, Under Armour Braided head band (discontinued as far as I can tell), Shock Absorber run bra and Nike sweat band (really any sweat band will do). Since it was daylight I also work my Nike Running sunglasses (Nordstrom Rack purchase from ages ago-but they never slip or fog and haven’t been damaged in multiple trips). It was warm inland where I started so I did not wear a jacket (I had brought along 3 Athleta running jackets for contingencies) and unfortunately this ended up being a really chilly run for me as I approached the ocean. I never warmed up and I think the cold made me run faster than I every have before for this quick run which sadly had little in the way of a view but had plenty of horse poo to assault the senses along the way.

After van#2’s first round of runs, we stopped for dinner and a quick rest before our overnight runs began. I curled up in the fetal position resting my head on my husband’s shoulder as he leaned against the window. In this gloriously comfortable position I got about 45 minutes of restless sleep. Then we were off to van#2’s second round of runs. Mine began in Yarmouth MA. Here’s how it went.

This was my overnight run. I have run in the dark before to prep for Ragnar but never truly in the middle of the night. The light and reflective gear made it impossible to garner an action shot but I ran in my Athleta Be Free tights and Stripe reflective, waterproof running jacket. The mist was heavy that night and it kept me dry. My Amphipod Xinglet reflective harness, Petzl Tikka+ headlamp, and Nathan strobe light met Ragnar code and totally did the job during a really, really, dark run. About a mile in a lovely young woman named Lindsay came up beside me. “I hope you don’t mind me shadowing you?” she asked. “I am really nervous in the dark.” I didn’t mind at all and we ran the remaining 4+ miles nearly side by side. It was reassuring when there were animal sounds by the roadside. I will say, though, that this stretch of run had one of the most generous side walks ever and that was appreciated.

When our second round of runs were over the sun was rising. We were at a critical decision point. We were close enough (an hour round trip) to our overnight cottage rental in Truro to refresh with a proper shower or we could try to catch 2-3 hours of sleep at our next exchange point in Eastham MA. As a trauma surgeon who often must function at a high level of performance for 36-40 hours in a row, I know that a shower is equal to at least 4 hours of sleep so I chose the shower. We all met up again at the exchange point in Eastham as van#2 began its final set of runs with my personal anchor run to begin in Wellfleet MA. Here’s how it went.

This was my unexpectedly long run. It was hot. The elevation was a bitch. I was on just 45 min of sleep but at least I was clean when I took off in my Athleta Maze Be Free knicker and Forerunner Tee (discontinued as far as I can tell). I wore my Brooks ventilated running cap (a TJ Maxx purchase from long ago) over my Under Armour headband to keep my head cool. I was a mess after this run. It was long, hot, and uphill. I was lucky that the van could stop at multiple points along the way to give me water and cheer me on.

As you can glean by the stats on my distance, pace, and heart rate, things got harder for me as time, distance, and elevation simultaneously increased. My heart was clearly working hard, at points clocking in at 170 bpm. You will also see that the Nike Running App running on my phone’s GPS, the Fitbit Charge HR app running on an accelerometer on my wrist, and the Ragnar maps are pretty good fidelity for a novice leisure athlete like myself in terms of mileage and route for each of my Ragnar legs. In the end, despite the challenges, I felt like a beast when it was all over and I know my teammates did too.

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As many of you may have gleaned I participated in the Ragnar Cape Cod Relay Race this past weekend. I had hoped to blog about it in real time with play by play blog posts but the vagaries of cell reception along the Cape and the gradual onset of exhaustion got in the way. Nevertheless, I have so many thoughts to share about what was arguably one of the best weekends of my life so prepare yourself for some #Bragnar reflecting on the race and so much more from friendship to fitness to fashion to a kick ass trail mix recipe.

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“The world ain’t all sunshine and rainbows. It is a very mean and nasty place. It will beat you to your knees and keep you there permanently if you let it. You, me or nobody is going to hit as hard as life. But it ain’t about how hard you’re hit, it is about how hard you can get hit and keep moving forward, how much can you take and keep moving forward. That’s how winning is done!” – Rocky Balboa

I have written before about how I think we over-coddle our kids these days, always making them feel like winners even when all they are is a solid mediocre. It’s rare these days for our children to feel like they did anything less than come in first; so, the sucker punch of not winning, when you tried really hard and truly, deeply thought you deserved to win, is a totally unfamiliar feeling.

Recently, my 11 year old daughter and her tween ethnic dance group participated in a competition. These girls practiced on their own well in excess of what the teacher demanded. They propped each other up. They were ready to hit is out of the park on the day of the show. And you know what? They did. It was a well-coordinated symphony of smiles and movement with pops of color in an eye-pleasing fashion. It was truly a joy to watch.

The girls were the last in their age group and genre to perform so when they hit the final dazzling pose of the dance I thought for sure they were going to win. But they did not. They didn’t even place. Everyone, girls and parents alike, was very disappointed. Like many, I was not sure why the girls didn’t win and it did bug me. So I said to my daughter in the aftermath of the dance competition, “That sucks but you practiced a ton, did a great job, and should be proud of that and move on.”

Personally, I thought this was a parenting highlight for me.

Someday my kid might not get into Harvard and she will be disappointed. She may not ever know the algorithm of the admissions committee but I want her to be proud of the accomplishments that gave her the feeling that she was competitive enough to apply. Someday the guy she has a crush on may end up dating another girl and she will be disappointed. She may not ever know what he saw in the other girl that she lacks but I want her to know that she is charming and beautiful and worthy of so many boys’ interests. Someday my adult daughter will apply for a job and walk away from the interviewing thinking she nailed it. But she still might not get the job.

Sometimes no matter how great and amazing and talented we are, we don’t get chosen. Occasionally, it is because we actually think we are better or more competitive than we really are; but, more often there is just an idiosyncratic way that these things play out in they eyes of those doing the choosing whether or not the choosers are utilizing strict guidelines. In the weeks after the competition, I have silently followed along as a number of other parents a launched an email trail of their disappointment. The initial disappointment brimmed into anger and then to demands to know what the judging criteria were, what the ethnicities of the judges were (in case they could bias the results), etc. There is a draft letter now that is presumably being sent to the leadership of the organization that hosted the event.

I get the disappointment but I don’t get the zeal to defend the girls’ honor so to speak. I have no idea if the other girls feel that same way as their parents. But, I do know that I don’t want my daughter to expect her parents to get into fighting mode whenever things play out in a way that doesn’t go her way because it’s a life skill to know when to move on. And, while I do want her to be brave enough to fight the fight when warranted (think Civil Rights Movement, Marriage Equality….,) I don’t want her to get worked up in a tizzy every single time things don’t go the way she was hoping. Life is simply too short to be in fighting mode that often. Rather I want her to learn to be proud of the interest, and the effort, and the lessons learned from each and every experience whether or not she walks away with a championship ribbon.

If we don’t let our kids experience disappointment and maybe even occasional heartache–fair or unfair– they will always believe that life is all sunshine and rainbows. I hope I am raising my kid to weather the clouds and storms that will surely occasionally cast a shadow on her adult life so that she can be resilient and keep moving forward. “That’s how winning is done.”

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Tired from lack of sleep, tired from the long hours, and tired from bearing witness to your destruction.

Tonight, you caused an accident while under the influence of alcohol. And, you are badly injured, requiring emergency surgery. Your liver is hard, cirrhotic, and unforgiving. Although I can get you through this first surgery, I know you will not survive. I know over the next few days, your broken and beaten liver will begin to fail, your kidneys will stop working, you will start bleeding from every orifice of your body, and you will die.

Tonight, I met your family. They thought you had quit drinking, but they asked, and I answered, “Yes.” “Yes” you had been drinking and “yes” your liver carries the scars of your addiction. “Yes”, it is likely you will not make it. I saw the hurt cross their eyes, the anger, the embarrassment. And then, the part that I dread the most, the part I was hoping wouldn’t happen – but it always does… They asked about the accident. They asked if someone else was injured. They asked if the other person was okay.

I see a shadow cross your daughter’s soul as her mascara weeps down her face and stains her arms. I see your son’s image of you crumble upon the impact of my words. I see their shame, their sorrow, with no outlet other than tears. Their heartbreak reaches out and stabs at me, their confusion begs my sympathy.

Tonight, another family is being informed of their loved one’s death… Their souls, and hopes, and dreams are extinguished with the two words, “I’m sorry”.

Tonight, you are blissfully unaware and asleep…disoriented, medicated and sedated because of your own injuries. But while you sleep, perchance you dream… of all the wreckage you have caused.

Tonight, you have blazed a trail of tears.

Tonight, I am angry.

Angry you didn’t know better, angry at all the hurt you have caused.

Tonight, I am angry.

Because I know this will happen again.

When does this end? When will you stop assaulting your body, your family and your friends? When will you stop tearing through lives, ripping out the hearts of people you know and of people you don’t?

When will you stop?

Please, let it be-

“tonight”.

Sincerely,

Your trauma surgeon

** This writing does not describe one particular patient or event, but is the unfortunate result of many patients and experiences I have had over the years. **

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My past efforts at transforming myself into a morning person have all failed miserably. There were occasionally times where there was a burst of morning joy (yes, I even made a top 10 list about why I should do this yet still failed) but inevitably the joy turned to despair and I returned to my usual ways of barely waking up on time for the latest I could possibly be where I needed to be. My mornings are typically a flurry of being in a rush and arriving at wherever I need to be totally cranky. People in my current job have seriously asked me when they first see me in the morning why I am so angry.

In college my worst grades were in the classes that started at 8:30 or 9:00am. Luckily by junior year such classes could be avoided. My choice of medicine was quite a challenge in this regard as medical education is decidely not 9-5. Thankfully the labs were you had to be present were all after lunch and the rest…well I will leave that to my lab partners to divulge (this was before ever class was recorded and notes available online thus precluding any necessity to be present for didactic portions of medical education). And residency/fellowship…. oh well, I can’t even begin to tell you how hard it was for me to show up at 5:45 every day but I had a spouse who has since the day we married (and is a morning person) been able to supply me with the requisite amount of caffeine in hand and boot my ass out the door in time to make it to rounds (but I did deliberately place at #1 on my rank list a general surgery program that did not require its interns to preround; yes, I am such a bad morning person that I chose a pivotal part of my surgical training to get out of that extra 30-60 minutes of work before 6am rounds).

While I have chosen a career where being on your A-game in the middle of the night is perfectly fine (in-house overnight call as an acute care surgeon; most grants, manuscripts, and data analytics can be done when my second wind hits in the evenings or overnight), figuring out how to fit working out into the mix of a busy surgical career and life as a wife/mother has been a challenge. Excluding mornings from this has made the challenge that much harder. Every day I say to myself, “No problem, I will just exercise after work.” Turns out I am great at lying to myself. Most days, I am just to tired or cranky or hungry after 11 or more hours at work (yes, even when not taking care of patients, it is a rare day that I am working fewer than 11 hours; I have tried to fix this and I am convinced that it is just not possible with a surgeon’s schedule) and find myself crawling to bed, face half-covered in drool, after having fallen asleep on the couch at some point with just 4-5 hours to spare until I have to be back a work.

A few weeks ago, emerging from a long, snowy winter some 7lbs heavier than the fall, I knew I needed to change my behaviors once and for all since saving workouts for the evening has not been successful was clearly not the solution when morning workouts failed to stick in the past.

Somehow though, when I travel for work (or for vacations for that matter) I am able to fit in morning workouts even on very little sleep. So with this current effort at conquering my not-a-morning-personitis, I analyzed my successes while away from home to try to make a major change in my at home routine.

First, travel requires forethought and organization that I don’t typically apply in every day life since every day life just happens whether or not I am trying. Part of that forethought is making sure I have my workout gear and that I set my alarm clock to be able to fit in a 30-60 minute workout.

Second, when I travel, there typically isn’t a couch to accidentally fall asleep on (note: stay away from suites for this reason) in a big heap due to physical or mental exhaustion the night before. So, on my pre-workout evenings while traveling I get under the covers, read or blog for a bit (I do more pleasure reading or blogging on a trip than ever at home), and let myself fall asleep in the proper place.

Third, away work meetings, though still painfully early, usually start an hour later than any of my work obligations while at home. (Bonus: west coast meetings give this east coaster’s not-a-morning-person ass the illusion of extra time in the morning no matter what time the clock says that meeting starts. Yah!)

Fourth, because I am a totally technological loser, I can never figure out hotel alarm clocks so I just set my iPhone to wake me when I travel. For some reason being able to wake up to a fake choo choo train sound works better for me than the shrill of a typical alarm clock.

Fifth, I typically don’t have the patience to find the local NPR station when I travel (yes, I know there’s an app but remember this is still the morning and we’re still talking about me conquering said morning so finding the screen with that app is an almost insurmountable challenge). Without a great NPR news story followed by another (since this is commercial free radio) and so on and so forth, without the familiar voices of NPR’s Morning Edition emanating from the clock radio, it’s just easier for me to abandon the hotel bed.

Finally, when morning arrives (even if it is at 5am), I am able to rise, brush my teeth, have my caffeine, and get dressed to workout over the leisurely course of 30 minutes or so before heading out to workout.

So here is how the detox happened. It started three weeks ago chosen deliberately due to an odd stretch of time where I was neither traveling nor on call (because being up all night tends to ruin multiple subsequent mornings for me).

First, I had to make my body understand that it was okay to be up much earlier than I need to be anywhere officially. So I started setting my iPhone to wake me up in the mornings since clearly I have no capacity to respond to my actually alarm clock. I just woke up, maybe had my coffee, and then stayed in bed while awake. This was it. Five mornings in a row I just got up early and did pretty much nothing. I just needed to get my body to get used to being up early and not rushing anywhere.

The following week, I actually got out of bed when the iPhone rang, brushed my teeth, had a cup of coffee, and got ready to work out (all without rushing). And then, I actually did work out. That week I focused on indoors in the home gym. No travel time. No pressure. No one to impress. I also conned my husband into joining me (I mean, I needed the coffee after all) and made sure there was something totally sinful to keep up with on the DVR. And you know what, it worked. Each morning for 7 consecutive days we worked out in the basement (and we blew through Newsroom, which I high recommend and moved on to Bloodline, equally compelling to get one up in the morning to see what happens next). On days that we did not time the alarms perfectly or pressed snooze a few too many times, we adjusted our run times to 30 or 45 minutes but 4 of those days we got in an hour long workout.

Each of those seven days was a great day for me. More energy when I got to work. No one asking why I was in a venomous rage when are arrived at my place of employment since I had worked all of that “I would rather be in bed” anger out of my body already. The evenings without pressure to try to work out only to be angry at myself for having not done it were so much easier. And, no more messing up my back by falling asleep on the couch in a contorted position. I would get myself upstairs and to my proper sleep location because I knew I had a morning workout I needed to be up for. I slept so much better. (It’s not that I didn’t know all of this already but transforming such knowledge into action was always the hard part.)

After two weeks of not-a-morning-person detox, I was feeling pretty good. The following week, however, had a few challenges. On Monday of that week, we were nervous for a family member and needed to be at a far away hospital pretty early and we blew it. But we got back on track the next day and it was getting to the point when I really wanted to work out in the mornings. But alas, some mornings are rough, especially those that require me to be at work before 7am. However, I was determined not to slide back to my old ways. So, on the days when even a quick 25 minute jaunt on a machine in my own home was out of the question we turned to the 7 minute workout. Yes, I am partial to the New York Times version of it. My husband turned me onto it. It’s what he did at the hotel when, during his last trip, every treadmill and elliptical in the crappy gym was taken by 5am. Sure, the workout can be repeated over and over for a great cross-training workout but even just seven minutes will get the muscles sore and the heart pumping so on the morning when the alarms just weren’t timed right to be at work for 6:30 and on the day that I had to leave at 5:45 to get my kid to her field hockey tournament on time, I worked out for exactly 7 minutes. But, hey it was better than no workout and it allowed me to stay on the wagon of morning workouts.

So, is this it? Is my detox process complete? Am I finally cured of my not-a-morning-personitis? Will I relapse? I am not sure.

But, this morning was the start of the fourth week and I got up and out for a quick 3 mile run and it felt good. I am hoping that my slow, calculated effort this time based on analysis past successes (as opposed to taking advantage of jetlag after a bout of traveling) will be the secret of life-long success in the days, months, years to follow. I give you permission as followers of the blog to hold me accountable. And please share your stories on how you make mornings work. I need all the help I can get to keep this up.

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2 years ago, I was on a girls’ trip out of town, and my best friend from high school dragged brought me to my first Pure Barre Class. It was not long after the birth of my child and I was getting back into the gym, eating better, and making positive changes to get healthy again. In fact, I had been working out with a personal trainer and entered into my first class thinking it was going to be “fun”. Ha. A few excerpts from my brain during that first class…

Those weights are small.

Why are these weights so heavy?!

Wait, that was only the warm-up?!

Ummm, why are my legs having seizures?

My leg is supposed to go where?

Sweet, I’ve made it. They just turned the lights down, that must mean class is over.

(*%! Dang. It’s not over.

My. Abs. Hurt.

I am definitely going to be feeling that tomorrow.

As you can see, this was NOT what I had expected. In fact, after that first class, it took me two months to go to my local studio. And when I did, I committed for one month only. So, how did all this change? How did I go from waiting two months before braving a 2nd attempt to now taking Pure Barre classes wherever I go and planning on taking my 500th class later this year?

1. Progress beyond the scale

It’s easy when trying to get back into shape to focus only on the numbers showing on the scale. And, yes, with Pure Barre I did lose weight. But, even before my clothes began to fit differently, I noticed other changes which kept me motivated … my flexibility improved – I could go further in my stretches and hold them longer. I progressed from not being able to do a single full body pushup to completing all of them during the warmups. My legs and shoulders started to show more and more definition. My strength increased – picking up my child became easier (despite his rapidly growing size!), and I began to notice less backache at the end of a long day at work. This workout changes your entire body, not just in pounds, but also in inches, in strength and in flexibility.

2. Inspiration outside of class

Pure Barre is challenging. Okay, let’s be real, it’s hard! And even though it seems unrelated, Pure Barre has really started helping my diet as well. Yes, there are some days I still *might* eat a cookie in the parking lot before class (hypothetically speaking of course), but lately I have really been asking myself – do I want to throw away all that hard work I just did by making this not-so-smart food choice? And let me tell you, after I have literally gotten my rear end kicked for the past hour, I want to make it count!

3. Classmates

I love my studio. I can’t say it enough. I’m sure some of this is because I work with a bunch of men for the most part, and it’s kinda nice to have some girl time, but I really do appreciate my time with the instructors and classmates. Bonds are made at the barre. Trust me, when you are pulling off of the barre, tucking, lifting, and shaking, the best person to understand what you are going through is standing next to you! These bonds carry over into “real life”, and I am now proud to count several of my classmates as friends. Plus, who else is going to help you glare at the instructor to start calling out “Final 10”?

4. Anti-ADD

Every class is unique – the exercises, the music, your classmates. This keeps the workout new and fresh and never boring. Plus, honestly, I’m not sure how you can get bored when you are sweating so much 🙂

5. Always something…

to work on. Whether it is going deeper into thigh work or working on the splits or building up to the 3 pound weights, there is always something to improve upon, become better at, or a new goal to set. And these new goals provide continued, new motivation to stay consistent both at the barre and at the dinner table.

So, here I am, celebrating my barre-versary, and thankful to my best friend who introduced me, the instructors who continue to push and inspire me, and my classmates who sweat with me.

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My little guy won’t be 7 much longer but here’s what I have learned in the past year about 7 year old boys.

Embed from Getty Images1) They don’t have an off switch. It’s constant full speed ahead until, of course, they spontaneously combust. For both the hyperactivity and the ensuing meltdowns, I suggest you invest in a good pair of ear plugs and an eye mask. There’s not point in fighting it and these tools will make you better at ignoring it.

Embed from Getty Images2) They have no fear. They will jump off of, charge into, ski down…, just about anything without consideration of the bones, ligaments, or internal organs at risk. The good news is, 7 year old boys are pretty resilient and most wounds at this age will heal without consequence. So enforce basic common sense and personal safety (e.g., helmets, no diving in shallow water, look both ways before charging forward) but let them wear their wounds like badges of honor.

3) They are always hot. They will wear shorts to school until December. In the middle of winter they will be shirt less when everyone else is clad in fleece. It will be -11 out (yes, that’s a minus sign and I don’t live in Antarctica) and they will refuse to wear a jacket. Be grateful for heated throws, Northface, and UGGs and just agree to disagree on the actual ambient temperature.

4) They love all sports. Even if you never encourage athleticism they will beg until they are blue in the face to do gymnastics, and football, and lacrosse, and skiing, and baseball, and karate, and soccer, and golf…. (You will wonder how they even learned about lacrosse.) Before you know it you will have committed all of your weekends for the next decade to your kid’s athletic pursuits so find a good family calendar.

Embed from Getty Images5) They know more about technology than you do. You may think you are savvy at limiting screen time but when your iPhone is on the futz they can fix it. If you want to rally for family movie night, you will have to rely on them to change the input on your AV system to Netflix. Oh well, you suck at IT but you may have future engineer on your hand.

Embed from Getty Images]6) They have fleeting interests (other than sports). Your dog will get a bowel obstruction from all the elastics that no longer are needed in that damn loom. You will realize the deep, searing pain of stepping on legos because all of those elaborate sets never make it back into their original boxes. You wonder is it Pokemon they are obsessed with or Minecraft… and one day you will find him doing Sudoku?! Well at least none of the above involve screen time.

Embed from Getty Images7) They don’t really want to snuggle anymore. They have too much kinetic energy to want to curl up with their mammas. They’d rather be doing something dangerous. They’re too hot to be tucked into your heated throw with you. You won’t be able to overcome the House Hunters vs. SportsCenter divide necessary for the TV watching snuggle. They are mad at you because in your technology errant ways you unintentionally offed one of their favorite tech toys. They are more interested in being big boys than little boys. You miss the old days.

And your heart breaks just a little as that 8th birthday approaches. Sniff.

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Growing up, I never would have considered myself very “Southern”. I spent my early childhood moving about the country and didn’t watch Gone with the Wind until the ripe old age of 13. However, after attending an all girls Southern prep school for six years, you can’t help but exit such an establishment with an education that extended beyond Latin and Physics. Not sure what I mean? Well, let me enlighten you as to what All Southern Women know….

1. The caloric value of any food item… With only a 10% margin of error.

2. That saying “bless his/her heart” excuses any comments which might directly precede or follow. For example, “My husband, bless his heart, would lose his head if it weren’t attached to his shoulders” or “She just doesn’t have the height for pageants, bless her heart.”

3. Pearls are an appropriate gameday accessory. And by gameday, I mean football…SEC football to be precise!

10. How to Accent the accent. Mostly to get what we want- whether trying to talk our way out of a ticket or yelling at our husbands to pick up their dirty socks… The accent is used in full force. And it works… better than a Jedi mind trick.

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As the snow continues to fall and fall and fall in my neck of the woods and the snow piles get higher and higher, my days and nights on call are filled with more and more poor souls injured (and occasionally killed) due to Snowmaggedon. So please listen up and do as you’re told so we can avoid a chance meeting in the trauma bay.

1) Are you an essential employee? If you have to think about it you’re probably not. I know it’s hard for your ego but your ego needs to be contained in an intact skull so consider the risk benefit ratio of your dead body vs going to work before hitting the roads.

2) You think running outside is waaaay more fun than running on treadmill? Yeah, I do too. But when the sidewalks are covered and the shoulders are shot, you’re just as much bait for wayward cars as a squirrel; so hop on a human hamster wheel and get your run on inside.

3) Are you blessed with super powers? No? I didn’t think so. So don’t try to defy gravity clearing snow off your roof. Use proper restraints or hire a professional to do that job because the snow doesn’t break your fall as much as it breaks your bones and internal organs.

4) Speaking of superpowers, what’s your kryptonite? Yup, it’s your snowblower. If it breaks leave it be. There are only two outcomes if you try to fix it, neither of them good. It will either stay broken or it will start again but your hand will be sacrificed. So grab a shovel instead.

5) See those icicles twinkling along the side of your roof line? I know they look pretty but remember they can impale you so just stay away. Far far away. Unless of course you are planning to get into a bar fight in which case the icicle is a pretty even match for the broken beer bottle.

6) Do you ever ski, snowboard, or bike without a helmet on? (If you do, just stay the hell away from a trauma surgeon’s blog!) Why would you treat any other high speed leisure activity any differently? So grab helmet before you head to the hill for some sledding.

Sure things need to get done in poor weather. Sure you need to protect your home and the valuables contained within it. Sure you need to clear your driveway and sidewalk. Sure you need to unwind and have some fun.

Just realize this winter wonderland can be fraught with dangers. Don’t be lulled by the twinkle of the glistening white powder. Be safe.

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I was traveling for work again last week. While I am not the typical business traveler, I do fly about once per month. It’s taken me a while, but over the years I have become a smarter traveler. Here are ten tips on what you need to do prior to take off.

1) Lose the 1-Quart Ziplock bags.

I used to hoard Costco size cases of these because I would take several on each trip as the original one inevitably failed. I now travel with a Tumisplit toiletry kit (sold as the Laval or the Lima or the Alpha 2 Split travel kit) that has a clear quart size half where I store all of my 3oz or smaller liquids and gels and two smaller clear zip pockets on the opposite side to store my tooth brush, cotton squares, razor, etc. I have been through security over a dozen times with this. No issues.

It’s easy fill said quart with all the liquids and gels a gal like me needs while away. If you aren’t planning to check a bag, this can be a problem. Luckily, while I am unwilling to part with many of my lotions and potions for hair, skin, and hygiene, I have found the perfect solution for moisturizer that saves me 3 ounces of room in my toiletry kit. Basin’s solid moisturizers don’t need to go in a 1-Quart clear bag but still smell amazing and relieve dry skin.

3) Bring along dry shampoo.

When I travel, I want to look my best. For short trips (this one was just two nights), I use my full size tools to show my wavy hair who’s boss before leaving (the index blow out). Once I have put in all this effort, I don’t want to just wash it out with the next shampoo so I extend my style with a travel size Batiste dry shampoo. The cherry scent doesn’t give me migraines and I get multiple days of shiny locks without an oily itchy scalp. Plus, I can travel with less shampoo and conditioner (yah, more room in the Tumi!).

4) But the blowout will need a little maintenance, so bring a mini flat iron.

Luckily most hotels these days have 1875 watts hair dryers so I don’t need to lug one withme. Of course, if I am extending my blow out I don’t really need all that power and I don’t want to take up lots of cargo space with my full size barrel brushes, 2 in curling iron, and 1 in flat iron. But I do have some waves and curls that spring back against the index blow out. To touch up these spots I use my Sephora mini flat ironto control the wayward strands after dry shampooing. The heat resitant bag is awesome for packing up on the last day right after getting ready.

5) Speaking of looking your best, no matter what make-up you choose to pack, you must pack the right make-up brushes.

6) Since traveling will wear you out, no matter what make-up you bring and how awesome your brushes are, you must never leave home without a highlighter.

YSL Touche Éclatis hands down the best beauty product I have ever known. While I could pair it with multiple other products to give me a slept like a baby look after a red-eye or a long night at the hotel bar apres meeting, what I really love about this product is that it is also a stand alone miracle worker. When my entire morning routine falls apart and don’t have time to hit the make-up bag, I can still almost fake sleep by just dabbing a little under my eyes and on my brow bones, along the sides of my nostrils, and around the upper lip. No other products necessary. Love this product. I wouldn’t both trying the competitors out there. YSL created this genre of beauty product and nothing else compares.

7) Unless it’s tropical on both ends of your trip and over all land masses in between, carry a packable coatwith you.

A few years ago, I made the mistake of traveling during winter from the east coast of the US to India without a winter coat. Yup, I just sucked up a slightly chilly ride to the airport leaving my coat at home figuring I didn’t want to lug it around India for a month with temps in the 80-90 degree F range. But I got stuck in London along the way due to a snow storm. No flights in or out for 3 days and I didn’t have a stinking jacket. So now, I have a packable down coat. If it’s cold at home when I am leaving, or if the destination is chilly or if I get stuck in another unexpected storm, it keeps me warm. When I don’t need it, it weighs nothings and takes up nearly zero space in my luggage. Plus, it can also double as a cozy little pillow during layovers or on the plane when compressed. I got my Active Basic Packable Jacket from Bob’s storesfor a steal and it continues to serve me well. The pix of the more expensive one from Land’s End below show the packability and pillow effect better though.

8) Along the lines of portability, never travel without ballet flats.

I love my heels for non-scrubs work attire and since I always workout when I travel a also bring a pair of cool kicks with me. For years, I would just throw on the sneakers for rambling through the terminal. Quite frankly, while I am totally embracing the sporty chic look on my weekends at home, I have decided that sneakers with quasi-professional travel attire is not the look I am going for. So now, I travel in my Tory Burch Caroline Flats. I honestly love these shoes so much that the biggest hassle these days is which color of the 5 pairs I own I should take with me. As a bonus, I can toss them in my work bag as a high heel rescue if ever needed in case of emergency during the business meeting.

9) Speaking of quasiprofessional attire, travel in comfortable pants.

I fly coach (I am in academic medicine after all). While lots of professionals travel clad head to toe in the suits/dresses they are intending to wear on the other end, I just won’t subject myself to that kind of discomfort. But, keeping the blazer or cardigan out of the luggage is a huge space saver. I used to travel in jeans but honestly I am just not in love with that look (though lots of men pull of jeans, button down, and blazer with aplomb and I don’t begrudge that eye candy). I have found that Athleta’s In Fusion pants and herringbone Chaturanga Leggings (both in black) pair exceptionally well with the black blazer or cardigan that I inevitably take on these trips with me worn over any one of my casual or more formal tops.

10) Invest in a layering topthat works for work and for play

I have already declared my love for Adea layering tops in this forum before. Nothing is more versatile or comfortable. I never travel without a white 3/4 sleeve scoop neck Adea top (but as you can see, there are other colors and I own 20 of them in various shades and shapes) I can wear it under short sleeve or sleeveless dresses and tops. I can wear it as the base layer under a suit. I can wear it as an undershirt under a blouse or button down. I can even work out in it if in a pinch and then hand wash it quickly. It dries in under an hour.

10.1) And finally, since you don’t want to risk running out of juice when your trying to follow this blog on the WordPress mobile app, get yourself a portable battery charger.

I have only had my Jackery portable charger since October and I honestly have no idea why it took me so long to get one. For years if would run out of power on my mobile phone in-flight (out of luck) or mid-meeting (need to hunt the periphery for an electrical outlet). I have even had to seek out post-meeting dinners based on weather or not I would be able to eat while having my phone plugged in. The solution to these battery life problems is simply having a back-up charger that is super portable, reliable, and matches most of my accessories. Bonus, I keep it with me on call too so I also no longer worry about running out of juice at an inopportune time in the midst of a 36 hour stretch at the hospital.

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My part of the country has been pummeled with snow in the recent past. Many local school districts had to cancel school 4-5 days in just over a week due to two substantial storms. The forecasters are predicting yet another 12-18 inches just in time for the start of the next school week. At this rate, we might be sending our kids to school on the 4th of July!

Sigh.

Yes, there are lots of reasons to sigh about this, even among the most ardent of winter warriors and snow lovers. There are already 50+ inches of snow outside my door (not including the plow piles, many of which reach well above 6 ft). There is nary a sidewalk or shoulder to be found. Many local roads can only accommodate one way traffic at a time and turning corners is down right hazardous with all the obstructed views.

All of this danger is when the snow isn’t actively falling, when the winds are not whipping flakes into a fury, when a slick, slushy layer is not sticking to the roads. When the bad weather is actively happening things get really hairy. And it’s typically on these days, when conditions outside really compromise the safety of kids at bus stops or walking to school or of any vehicle or persons on the road, that we get a snow day.

The other day, on the heels of our many recent snow days, the local NPR station had a whole call in segment on the burden of snow days on families. Caller after caller lamented the challenges for working parents, single working parents, parents of disabled children, parents without telecommuting options, parents with part-time or hourly jobs (who simply don’t get paid if they don’t go into work), parents whose own parents can’t provide back-up childcare…. It went on and on.

The radio hosts and some callers discussed viable options for snow days such as alternating days with neighbors so that at least some of the folks in the neighborhood could go to work. Others spoke of progressive employers who offer on-site back up childcare or access to on-demand in-home care through external agencies. Some suggested schools should stay open despite inclement weather to provide kids safe place to be in a storm and make sure they don’t go hungry.

I suppose I should have been sympathetic to these snow day woes and interested in the proposed solutions as the parent of two school aged children who often must be at work no matter how inclement the weather is, but instead I was bothered by the idiocy of it all.

Let me tell you why.

It looks peaceful but the roads are treacherous.

I know what it’s like to have to travel through treacherous conditions to get to work. I own an all-wheel-drive car. I live close to work. I know enough to leave plenty of time. Yet, I have still experienced my life passing before my eyes as I slip, slide, and fishtail the 4.5 miles to work on those days when patient care requires me to be at the hospital. I know what it’s like to hunker down at work with 4 days worth of clothes and rations when anticipated conditions suggest it would be unsafe for me to travel back and forth from work. I have no choice. This is what I signed up to do. You may need me, and I will be there for you in the trauma bay.

But you know what…don’t the majority of us have a choice? In fact, should it even be a choice to put oneself and others at risk if what you are going out of doors for is considered non-essential work (to use a state of emergency term).

I know that nearly 100 people died with thousands more injured during the Blizzard of 1978. I know that the pro-active state of emergency declarations due to accurate prediction of epic storms (yah 21st century weather forecasting technology!) in the modern era (first, two years ago this week and again last week) has kept many people safe. I know this because I had to be at work and it was eerily quiet in the trauma bay. I also know that on these other days of seemingly non-epic storms, when the predictions for danger aren’t as dire, that the ED is like a war zone, filled with people who ventured out only to get injured, some in fender benders and others in major pile ups. I know that some of those injured people die no matter how hard we try. I know from my most recent call on a snowy, though not state of emergency, day what it’s like to code and code and code a 30 year old whose Civic was no match for a semi on a treacherous interstate, only to declare him dead. I know the sinking feeling of getting that message that your child’s school bus has been in a crash on a day that school was not cancelled despite the falling snow. (Luckily it was minor and no one was hurt but it could have been very different with 40 kids piled into the ED and the trauma bays instead of driving their caretakers up a wall at home on a snow day).

My daughter’s bus stop circa this morning. No where to stand.

So that’s the thing about snow days. I get that they are inconvenient all around. But it’s not just about keeping our kids safe, not just about the walkers who don’t have cleared side walks or lack of space at designated bus stops. It’s about the safety of everyone else around us too. To me, preventing one injury, even one death, is worth all the inconveniences. Back-up employer-based childcare (though wonderful when your nanny gets sick on a normal weather day) involves putting both you and your child (children) at risk on the drive to your workplace. Calling in a care provider in a pinch puts that person on the road and then you too will make have to make your way to work in poor conditions. As we learned this week, public transportation isn’t always a viable option to avoid the roads and be safe. Similarly, while the carpooling equivalent of watching kids on a snow day in the neighborhood seems great, how would the ones who drew the short stick and got stuck with the kids (this to me was the tone of the call in show) feel when the other mom or dad across the way never came home that night (and not because they were on call at the hospital)?

Are these inconveniences too terrible in the name of safety? Because I do believe that if it’s too dangerous out there to get our kiddos to school then it’s likely too dangerous for the rest of us (unless, of course, you are a considered an essential worker like I often am). What does it say about our world today that in some districts families are so strapped to put food on the table that putting kids in harm’s way in order to be fed is preferred over a snow day? Why do we tolerate employment policies that punish the least affluent among us in hourly or part-time jobs with lost wages (or worse, threats of termination after so many missed days) for something as legitimate as unsafe travel conditions? Are those industries not involved in the assurance of public safety (our dedicated fire, police, and EMS providers) and necessary urgent/emergent/long-term care (our inpatient, ED, and SNF/LTAC/home services nurses, doctors, aides, etc.) so important that they can’t take the financial and/or productivity losses of a few extra snow days here and there to have fewer injured (or possibly dead) employees?

Parking for many of our surgeons inaccessible.

Notably, many healthcare systems are no better, keeping their elective schedules and outpatient clinics running despite inclement weather. Yes, there is pressure to attain patient satisfaction but why should we put all the doctors, nurses, admins, patients, and families at risk for hernias, and wound checks, and well visits, and routine follow-ups for chronic diseases that could easily wait for another day. Yes, that means when the next clinic day or OR day is quintuple booked workers will have to work harder and stay later and patients/families will have to be more patient but at least we won’t be coding someone who was headed in for a non-life-threatening issue during a snow storm. Those unfortunate enough to experience life threatening issues on those days will have access to the rest of us fire, police, EMS, ED staff, trauma surgeons…. I promise.

So, when our superintendents who have considered the forecast, reports of road conditions from our DPW, and the possibility of keeping the schools open until July give our kids a snow day, why not just declare it a snow day for everyone except those few essential workers who must compromise their own safety to get to jobs that provide services for everyone else’s safety and well-being?

Me in the trauma bay during Storm Nemo, February 2013.

Not every storm warrants a state of emergency and not every snow fall warrants a snow day. And depending on where your home is located relative to your workplace, the two may not both be experiencing the same weather conditions. But when things are rough out there, let’s quit complaining about the burden of snow days. As a whole we need to exercise more common sense and implement policies that keep families and workers (even if they don’t have school aged children) safe and out of the trauma bay.

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Forget Dante’s Inferno. After having my sweet baby kidnapped and replaced with a toddler months ago, I have now realized toddlerhood has it’s own circles of hell. Forget Happiest Toddler on the Block, I should have read Sun Tzu’s Art of War. No, this is not a blog piece belaboring the point about toddlers being a**holes, because I don’t believe my child is one… okay, fine, at least most of the time. What it is about, however, is now being the parent of a human being who has more feelings and wants than a new diaper and a bottle, but not enough emotional maturity or life experience to understand priorities, logic, or, for the love of God, social embarrassment.

1. Potty Training

Great, now I have to introduce words about bodily functions and appropriate anatomy to my child who repeats absolutely everything, to anyone, at any time. Nope, don’t see any awkward moments on my horizon…ugh.

2. Big boy/girl bed training

Woohoo! My baby is sleep trained – getting at least 10 hours of restful sleep at night, and mommy and daddy are now rested individuals. Oh wait, now I have to train a human who has the self-control of a gnat to stay in his bed – all night? Two words for you – SOMA bed. For those of you uninitiated, this is used in hospitals for patients who are not able to stay safely in their beds. Think a pack-n-play but with a roof :). So, to my coworkers: if you see me rolling one of these babies down the hall, don’t worry, I promise to return it…sometime next year.

3. Childcare inconsistencies

It didn’t particularly matter before who gave my child his bottle, because bottles are pretty much given the same way by everyone. However, because I really do require a metropolitan city instead of a village to help with childcare, the inconsistencies are becoming glaringly obvious. I am eternally grateful for everyone who pitches in to make our world work. However, my little stinker has quickly figured out how to manipulate each and every one of us. Like, when I come home at night and my child looks like a cocaine addict, with powder all over his face and hands…albeit the powder is orange, instead of white, and came from a half-eaten bag of cheese puffs instead of the leaves of a coca plant. My husband’s response, “well, I asked him what he wanted to eat, and he said cheese puffs.” %#U@$^* Of course he did, he’s 2, and a certifiable cheese puff addict! What did you expect him to ask for?! Green beans? Which leads us to our next circle of hell….

4. Dinnertime

Overall, I approach dinnertime like war. Yep, war. I swear my child acts like being forced to sit in one spot and eat food is the equivalent to waterboarding. I wish someone would make me sit down and eat food that I didn’t have to cook! Anyways, the battle begins with the attempt to capture the enemy child. This might sound easy, which let me tell you those little suckers are even more slippery than escargot (https://www.youtube.com/watch?v=IQzk4vTBUDs), and let’s hope he doesn’t decide to become an invertebrate. Next, are the attempts to keep that little butt in a chair long enough to actually insert food into his mouth. Sadly, gone are the days where they could be locked secured into a high chair. I continue to wonder what happened to my happy child who eagerly ate avocado, calamari, and hummus. He has now been replaced by a version of Buddy the Elf (https://www.youtube.com/watch?v=DS8MegEiKLk) who believes strongly in trying to stick to his 5 major food groups. Which are, in no particular order…

Pancakes

Oatmeal

Waffles

Cheese puffs

Popcorn

Since I clearly want him to eat outside of these “food groups”, next comes the attempt to basically trick him into eating real food. This is where solid espionage skills are required. Just “hide” the vegetables you say? Ha! My two year old is a much trickier opponent than that. See for yourself –

I know it is kind of dark, but this is an image taken from a video of my 2 year old eating mashed potatoes, with corn mixed in. This is photographic evidence of him spitting out each and every individual kernel of corn after every possible molecule of mashed potatoes had been sucked off of them.

Sweet.

5. Preschool

Preschools are a racket. You want me to pay how much for 3 half days a week? A mandatory play evaluation? Umm, okay, sure. I’m not exactly sure what watching my kid alternate between picking his nose and putting a puzzle together will tell you, but sure, I get it… I guess. Wait, he needs more testing before he can be offered a spot in your preschool? Oh, it’s a psychological evaluation? Umm, because you have been burned in the past accepting all those pyromaniac 3 year olds running around? Are you f’ing kidding me? What sort of psychological evaluation can you perform on a toddler? My kid doesn’t even remember what he ate for dinner last night, likes to run in circles until he falls over, and thinks the sound of him passing gas is the best joke ever. Can’t wait to see how this turns out…

To all my toddler parents out there – hang in there, my brothers and my sisters in these battles of will. Soon, they will be over… but so will those sweet requests to cuddle and sloppy wet kisses at night. Toddlers truly are Sour Patch Kids, sour and sweet all at the same time. Like it or not, this phase, just like the candy, has an expiration date.

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In recent conversations with friends of mine who are pregnant, it became abundantly clear whether this was their first child or third, pregnancy in your 30’s tends to be pretty different than pregnancy in your 20’s. As a shout out to all my AMA (advanced maternal age) moms out there, and as an attempt to humorously remind people to be sensitive to their friends undergoing fertility struggles (no matter what age!)…

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No one ever wants to meet me…Well, at least inside of a hospital. If you are meeting me in a hospital, it is likely because you have been stabbed, shot, assaulted, or in a car accident. Although the only advice I have about avoiding the first three mechanisms of injury is to stay away from “two dudes” and not try to sell Bibles on the street at 2 am, I do have some more specific advice when it comes to car accidents. In my non-scientifically proven experience, the majority of my patients are in the hospital due to someone’s bad decisions – either their own or someone else’s. And don’t get me wrong, I make bad decisions all the time. For example, I ate a chocolate doughnut this morning for breakfast. However, no one ever expects their seemingly small bad decision to text their husband, or try and beat that red light on the way to work to result in their meeting me at the hospital. But it happens. Every. Single. Day. So, stay safe America, and here are some trusty driving tips from your friendly, neighborhood trauma surgeon.

1. Seatbelts are good, especially if you are pregnant.

I am not going to go into how many pregnant women (just in the last year alone) I have seen ejected from vehicles during car accidents and try to describe the tragedy that ensues. However, no matter who you are – old, young, short, tall, overweight, or what trimester of pregnancy you are in, wear your dang seatbelt. It saves lives, and there is absolutely no excuse whatsoever to NOT wear one. So, can you please just wear it? Tire marks across your belly are just not a good look.

2. Texting is bad.

I know it is hard for some of you young grasshoppers to imagine, but back in “the day”, phones needed to have wires. Therefore, they were only located in places with walls and telephone jacks. Meaning, somehow, I was successfully able to be a teenager and not communicate with anyone for the 15-20 minute drive between my house and my destination. And, believe it or not, my social life did not suffer. There is nothing in this world so important to make you pick up your phone at all while driving. Life seemed to go on just fine before this capability, and you have a much higher chance of your life continuing to go on if you forget that this capability exists.

3. Let’s talk about alcohol.

I get it, alcohol seems to have some pretty magical powers. It will give the average Joe the comedic powers of Jerry Seinfeld. It can even make your 60 year old neighbor look like Heidi Klum. But it will not make you a long-lost member of the Andretti family. In fact, it won’t make you a better driver of any vehicle in any way, shape, or form. It will make your reaction times slower, and your likelihood of being involved in or causing an accident exponentially higher. This is true for driving cars, mopeds, motorcycles and yes, even golf carts. Let me also tell you, from my non scientifically-proven experience: You will probably be fine. But, your friends riding with you, or the person that you hit with your car will not be. And living with the guilt of confining your best friend to a wheelchair for the rest of his or her life is probably something you don’t want. With so many designated driver services out there right now, there is just no reason to drive yourself after you have morphed into your Jerry Seinfeld alter ego.

4. Speaking of the Andrettis…

Speeding really will not get you there any faster. And I can prove this mathematically. The average commuter travels 15 miles one way, with an average trip lasting almost 26 minutes. Increasing speed by 5 – 10 miles per hour for short periods of time is not going to shave your commute off by half. So, if you truly are running late, driving faster is not going to make up any considerable amount of time. You, in fact, will still be late. And let me tell you, being 10 minutes late to work is waaaaay better than not showing up at all.

Think I am exaggerating? Don’t want to follow any of the above advice? Don’t worry. I will still be here… at the hospital… waiting to cut off all your clothes, see you naked, and then charge YOU for the experience. Oh, that doesn’t sound like fun? Oh, well in that case, re-read the above, and we can meet for coffee instead.

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Here at Outside Hospital (OSH), we are 100% committed to your satisfaction as a patient. To this end, we have created this pamphlet, which contains some tips and advice to guide you in your hospital stay, and we will be providing this to each and every patient immediately upon your arrival to the hospital. Even if you have slurred speech secondary to a stroke, been shot multiple times, or don’t even know your own name, don’t worry, we won’t bother you with pesky ekg’s or mental status exams until we have gone over this information, in detail.

1. Please try not to confuse us with a hotel.

I know, I know, the free cable, hot breakfasts, and lumpy mattresses all create an atmosphere that is incredibly confusing since it resembles your favorite Holiday Inn. However, we actually are a hospital, not just a bunch of beds filled with some sick people. So, that means that your breakfast may not be the equivalent to IHOP’s, we might not have Comedy Central as a choice of channels and sometimes, when your doctors come into your room, they might have to turn off the television so they can discuss your health. Although I know these lack of conveniences might lead you to believe that you are in a third world country, they probably don’t deserve a one page written complaint.

2. We CAN make you have zero pain.

All it will involve is a breathing machine, a continuous infusion of general anesthesia, and probably a one week stay in our $8,000 per night intensive care unit. However, if you don’t opt for this premium platinum package, you will have some pain. You literally got hit by a bus yesterday, have a broken leg, 6 broken ribs, and had emergency surgery to take your spleen out. Unfortunately, it is probably going to hurt. Yes, even if I give you that pain medication that starts with a D followed by some benadryl because the D drug makes you itch and some phenergan because the D drug makes you nauseated… injuries hurt. Our abilities extend only into making the pain manageable, so that you can get out of bed and participate in your care.

3. Sometimes we may have to ask you for legal documents.

We understand and are very proud that here at OSH, we have the most romantic environment you can find. Girlfriends are constantly becoming fiancees, fiancees become wives overnight, and ex-wives even can become wives again! It really is remarkable. Unfortunately, however, when 2 women show up claiming to be your wife, and legal signatures are required, we may ask you to show proof of your relationship. So, to help you, we have included our local County Clerk’s contact information on the back of this handout, so you can easily provide us with a copy of your marriage certificate.

4. You may be subject to drug or alcohol counseling during your stay.

WE believe you. We totally understand that your urine drug screen showed cocaine only because you had sexual intercourse last night with a woman who was using drugs. Unfortunately, the CDC does not currently recognize cocaine or even heroin as a sexually transmitted disease, and we are required to offer counseling when drug and alcohol screens come up positive.

5. Allergies.

Let’s talk drug allergies for a moment. Allergies are slightly different than side effects, and include reactions such as shortness of breath. Nausea, for example, is a side effect of a medication and means that you can actually still receive the drug in question. In addition, narcotics all act similarly. Therefore, although you might think that you are allergic to every single pain medication except for that one that starts with a “D”, that probably actually isn’t the case.

6. Your doctors all went to school.

For a long time. We promise to provide you with real medical doctors who are all incredibly in debt to provide you care. WE also understand that Google provides everything anyone needs to know, but our doctors are kind of picky, and they do expect you to trust their knowledge. Therefore, we do encourage you to listen to them. Especially when it comes to the importance of getting out of bed. However, don’t worry, here at OSH we have you covered. Should you decide to ignore your doctor’s advice – refuse to get out of bed, for example, we have the knowledge and expertise here to treat the decubitus ulcer on your bottom that you will invariably get. We are particularly proud of our decubitus debridement program, and you are welcome.

Thank you again for choosing OSH, we are proud to be healthcare providers and look forward to taking care of you during your time of illness. And don’t forget, please fill out your comment card letting us know how well we did at the end of your hotel hospital stay.

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Merriam Webster defines professionalism as “the skill, good judgment, and polite behavior that is expected from a person who is trained to do a job well”.

In the past 3 weeks, a few things have happened that have brought this topic to mind. To give you a couple of examples:

While watching the celebrity apprentice, my au pair made the comment that it wasn’t fair for the teams to be split by gender – that the women were at a disadvantage. I expressed some surprise by this sentiment (being a product of an all-girls’ high school and all), and asked her why. She replied, “Because women don’t work together well.”

Two weeks ago, one of the ER nurses asked me if I had been a nurse before I became a doctor. One of the best indirect compliments I have ever received. This is a “big deal” so to speak because growing up, (and by growing up I mean in medical school and residency) as physicians you are taught certain life “truths”, which vary by specialty and by gender. One of these “truths” is that nurses and female doctors do NOT work well together. It is whispered about and discussed as fact, passed down from generations of residents before you – nurses will give you a harder time, they are nicer to the male doctors, don’t let your nurses call you by your first name because then they won’t respect you, etc, etc.

Another friend who has been very successful at her job and has all the evaluations to prove it is leaving this job. Partly because her evaluations are filled with not just job performance reports but also reports about her personality. Personality? Really?! I don’t mean unprofessional behavior – cursing, being verbally abusive, etc, I mean personality. Like, your personality is “too assertive”, etc.

So this really got me thinking – can women really NOT work together? Are we NOT able to give or receive constructive criticism and feedback professionally? Are we subject to interpretations of our job performance based upon how well-liked we are instead of how efficient, productive, and skilled we are?

Every Friday morning, I attend “M&M”, aka morbidity and mortality conference. This conference is well-known to surgeons everywhere. In this conference, complications are presented in a PowerPoint format, with at least a 34 sized font, and flashed up on a huge screen in front of all the surgeons in our department to dissect, comment upon, and quite frankly, judge.

So for those of you not in medicine, let me try and describe it to you in a way to makes this process hit home. Think of your last mistake at work – maybe you missed or forgot a deadline, flubbed a presentation, didn’t make the best impression on a client. Any mistake you can think of – large or small. Okay, got one in mind? Now, think of a detailed report on that mistake… a timeline describing all of your missteps or mistaken thoughts… when these occurred, whether they were witnessed or not, your boss’ account of what happened, your secretary’s impressions of what happened, the outcome of the mistake, and a poll of similar people in your position around the country and whether or not they have made that same mistake also. Your worst and most embarrassing moments, picked at, highlighted, judged, written down, projected on a screen, and worst of all – viewed by everyone in your office, company, etc. Have chest pain yet?

Well, this is what your surgeons do every single week. Luckily, most of us don’t have our own complications presented every week, but it happens to all of us. And, we all have to learn to be “professional” about it. In other words, we have to be sensitive enough to our mistakes to not make them again, but not so sensitive that we can’t move on emotionally and be productive. In other words, not take things too personally. We have to understand that these mistakes we make are actions, not personality traits. I am not a “bad” person because I made a wrong decision. One of my favorite surgeons from residency always said, “The last thing a patient needs is a surgeon who feels sorry from himself.”

Okay, okay, so what the hell does this have to do with women as professionals?

I can clearly delineate and separate professional actions and personal happiness, because I have been trained to do so. Quite frankly, given my years spent attending and participating in M&M conferences, this “skill” is critical to emotional survival and professional success. I have to keep the emotions at bay so I can accept the criticism in order to make myself better. I am not perfect. All I can hope is that I will be better tomorrow than I am today, and sometimes I need help with that. And sometimes that help is in the form of criticism. However, most women don’t have to sit through an M&M conference every week, and I feel struggle with this ability to separate the professional from the personal.

Let me be blunt, Women will never achieve the same levels of professional success as men, until we act professionally TO EACH OTHER, and think and judge OURSELVES as professionals.

So, do I have this all figured out? Hell, no. But here are some thoughts and advice on what has helped me.

All female relationships can be tricky… if we let them be.

As a species, most of us are plagued to some degree by insecurity. We are taught at a young age to be people pleasers, and ergo a lot of us judge ourselves by how well we please other people. In addition, we unwittingly often compare ourselves to other women, regardless of the differences in our situations. For example, I found myself one morning, sitting in the pediatrician’s waiting room, comparing myself to another mom with a similarly aged child. I had just finished working over 24 hours, and looked every inch of it. She was enviably thin; her hair, her makeup and her clothes were well appointed and fashionable. Her toddler belonged in a GAP ad. I looked slightly homeless with my child still in his pajamas and covered in maple syrup from the pancakes I had bribed him with on our way to the appointment. I caught myself judging how I am as a mother and as a woman based on the appearance of a complete stranger in a damn waiting room. I have two degrees, am a double boarded surgeon and found myself in a thought process that was a complete waste of 5 minutes of my life that I will never get back. I don’t know this woman, so why the hell was I envying her? Because, regardless of education, our successes and accomplishments, that is what many of us do. We judge our worth, our success at life, by how we compare to other women. And this, is absolutely absurd.

When two dogs meet, there are cautious glances exchanged, followed by some evaluation at a distance, then some butt-sniffing, and ending with a silent acceptance of the other animal’s existence, or some baring of teeth, or some tail wagging. We, as women, are similar – well, without the butt-sniffing (in most cases). When we meet another woman, often times our insecurities dictate our behavior and our opinion of her… however unfounded those opinions might be.

Now place all these behaviors and thoughts in the professional world, and let’s complicate matters by adding a real, or implied hierarchy.

Overall, this milieu can lead to a level of discomfort amongst women who are all on the same team, but with different roles and qualifications. However, I am here to tell you that this discomfort can be overcome. I am blessed to have worked with an amazing group of nurses throughout my career, and even though we aren’t “supposed” to work well together, we do. In fact, I count many of them as very close friends.

My advice for success in the professional world as a woman, whether you work in a predominantly female world or male world is:

Have the confidence to separate the actions from the person.

In other words, learn how to give and receive negative criticism professionally. Whether you are the one that “messed up”, or you are the person giving feedback to a colleague, separate the personal from the professional. She or he isn’t “mean” because they gave you constructive criticism or had to address an issue with you. If you have an argument or disagreement with a colleague about a project, is she or he really being “difficult” or are you just two people with two different opinions and perspectives? You don’t need to and ask your boss if he or she is “mad” at you because you failed to meet a deadline or ask your colleague if she doesn’t “like” you because you had a disagreement. Keep it about the job! Ask instead how you can improve, what could you have done better.

Keep the emotions in check… in public, at least.

We have all had those days – when nothing is going right, you made a mistake, disappointed yourself or your boss with your performance, you have had a disagreement with your colleague, etc. It is completely normal to have emotions, even strong emotions about things that happen at work. I’m not saying you can’t have those feelings, I’m just asking that you to please not consider the public water cooler as the place to express your unfiltered, raw emotions. Nothing wrong with crying, ladies. There just isn’t any crying in baseball. Hold it together until you are in your office, locker room, bathroom, etc. It is hard to be taken seriously in a career if you are viewed as fragile, or a bundle of nerves and emotions.

Finally, for the love, let’s learn to Respect, Respect, Respect each other.

Let’s stop calling each other bitches.

Let’s start accepting and embracing our differences.

Let’s stop viewing our mistakes as personal faults.

Let’s start giving and taking negative criticism with CONFIDENCE.

Let’s stop judging ourselves based upon our impressions of other women – This leads to feelings of insecurity, which often leads to actions based on insecurity.

Let’s start having the CONFIDENCE to embrace and support each other, and let’s start proving everyone WRONG. Functioning as either boss or employee, women CAN work together well, succeed, and LEAD.

This kind of socialization, as the blogger describes it, has so many consequences for women: body-shame, low self esteem, wage and promotion inequities, victim blaming in cases of rape and sexual assault. The list goes on and on. The consequences are real.

Let’s not raise our boys to think this is normal. Especially important now since our President perpetuates one extreme where men get a free pass for any kind of behavior, even criminal acts, if they happened to be ‘turned on’ by a woman and our Vice-President perpetuates the other extreme wherein merely being alone with a woman might cause him to have feelings of arousal so he won’t do it.

In college, soon after I got my first bank account and a credit card with a $300 credit limit, I started keeping every receipt for every purchase I ever made. At the end of every calendar year, I would box up an annual pile of receipts. This continued until a few years ago when my husband decided he could no longer tolerate me forcing us as a family to save every receipt filed away into individual envelopes for necessities, frivolities, groceries, gifts, etc. He was right, outside of certain big ticket items and shoes from Nordstrom, there really was not any reason to “hoard” receipts (his words, not mine).

It’s been a tough habit to break. Now, when I empty out my wallet after a few days I scan the receipt for what I purchased and then cringe as a toss it. Every. Single. Time. Not sure if it’s just me still trying to break the habit or some weird paranoia that I will truly someday miss having proof of purchase for that t-shirt from target or that gallon of milk.

In any case, during some spring cleaning yesterday I came across all of my receipts from those college years. It was a fascinating lens into my past habits and routines. He’s what I remembered/learned about myself all these years later.

I bought a lot of feminine hygiene products. A lot.

I spent a lot of money on photocopies and laser printing.

I ate out. Often. And, surprisingly I can remember who I ate with for each of those meals away from our usual two or three go-to restaurants. Making the effort to go somewhere more expensive or (gasp) leave the general vicinity of campus = a special occasion and I found myself imagining everyone who I thought was special to me all those years ago.

I didn’t, however, indulge in snacks at convenience stores or similar. This is notable only because I am married to someone who definitely did.

I always love to shop, it seems.

I never paid more than $19.99 for any of my shoes or clothes back then. Typically, my stuff came in well under ten bucks.

I owe a special thank you to the Wexner family of Columbus, OH. Were it not for their Limited/Express stores back in the day I might have had to go through college naked.

I even once purchased something at an Abercrombie & Fitch store. This must have been before I developed migraines in response to strong perfumes or colognes. I won’t allow my daughter to shop there (at least when I am with her) because it’s some sort of moral stand I decided to take for reasons related to the forced inhalation of strong smells as I walk by their stores in the modern American mall. I have always denied ever shopping there; evidently, I am a big liar.

I never bought anything that would be considered athletic. Nope. Not a thing in which one could workout. This is regrettable, not only for the fact that it is evidence of my complete lack of physical self-care back then but also because it likely led to the backlash known as my current Athleta problem.

I got just a bit nostalgic that Caldor, Lechmere, and Filene’s no longer exist.

I evidently was also the kiss of death for any bank I decided to do my saving with. None of the three banks I used during those years exist today.

I used to listen to a lot more music than I do now. Today I could stream constantly if I wanted to but honesty I don’t ever listen to music outside of my car or on workouts. Back then between mail order and the local Tower Records, I bought a lot of CDs.

I enjoyed live music far more often than the concert every couple of years I enjoy today. But, there was no genre in particular that called my name as was evident from my ticket stubs for House of Pain, Duran Duran, James Taylor, and They Might Be Giants. And, as with those special dinners, I remember exactly who I saw each of those shows with.

If there wasn’t live music to be enjoyed, I went to the movies. I saw some great films and some mediocre ones. I often sought out art house cinemas for limit release films. I didn’t just seek out the big screen for films whose effects would warrant the time, effort, and cost of going to the movies [read: the only movies I have seen in the theatre in the last 3 years are the 2 Star Wars movies.] I simply enjoyed going to the movies back then unfettered by the logistics of sitters and evening little league games or by the gravitational pull of my pajamas at 7:30pm.

Occasionally, I went to a play but I was not so much a theater person. Rather I was an ardent supporter of my friends who ran the set, played in the pit, or were making their acting debut on their way to become ophthalmologists, lawyers, and Drosophila experts.

I clearly went out a lot. But when I was in, I spent a lot of time on the phone at substantial cost. If I had invested the money I spent on hours of late night calls with my best friend from home, she and I would be enjoying some really tricked out girls’ weekends now. Calling friends came at a premium back then. Now, we have unlimited minutes to talk yet we rarely do; and, if we do it’s for minutes, not hours.

I was proud of the fact that I worked to finance all of these “frivolities” that lightened my college years. I made $65/week at my work study and always deposited $40, spending about $25 on the typical weekend (Thursday night through Sunday brunch back in those days — never paying for a brunch until years later because, well, dining waffled were just that good) and putting away the rest for my phone bill and summer adventures.

I didn’t really have any real adventures, though. I visited my sister and my best friend in New York a lot. I had a great trip to visit my roommate on the west coast our first summer after college. And, yes I saved every boarding pass and bus ticket. Greyhound and Peter Pan still exist but wow my TWA ticket for the *non-smoking* section was a real blast from the past. As was that boarding pass for my first every Southwest flight in 1993 — an experience that kept me from using this airline for the ensuing nearly a quarter of a century until driven by desperation about 2 years ago.

I wonder what has happened to the carbon paper industry. I miss the satisfying mechanical sound of the credit card impression maker thingy. The screeching feedback that it’s time to remove my chip is not the same.

I also miss my original signature with first, middle, and last name fully legible.

It was late. I had just finished a straight-forward appendectomy. I explained the findings and expectations for recovery to the family gathered in the waiting area. There were a lot more people there than in the emergency room just a few hours earlier.

“Yes, he will most likely be going home tomorrow morning,” I answered in response to a final question from a family member. I shook the mother’s hand and turned to walk away. Everyone’s expression was one of relief. It’s an every day diagnosis and procedure for us; for them, it’s quite possibly the scariest thing to have happen to a love one.

Except it wasn’t.

“I think I know you,” I heard when my back was already turned. “Do you take care of people in car crashes?” It was a timid inquiry.

“Yes, I am an acute care surgeon. I do trauma and emergency general surgery.”

It is the Presidential address delivered recently by Dr Caprice Greenberg to end her term as President of the Association of Academic Surgery. She speaks with clarity and conviction on a topic of importance to both men and women across generations of surgeons. She provides data, vivid examples, and eye opening analyses about how and why women are professionally held back, not just in surgery but across specialties and other professional roles.

I will be joining a woman’s march tomorrow. Whipped up this embroidery project post-call. Fabric was a bit thin and hooping is still very hard, especially with two designs to merge into one line. But it makes the point. Today our nation moved from unconscious bias and micro aggressions to the normalization of racism/xenophobia/homophobia/etc. and oppression. So tomorrow I march for: Gender equity. Pay equity. Marriage equity. Health equity. Education equity.

I grew up in a home with the subtle lingering sorrow of parents who have lost a child. An older brother I never got to meet.

I have dear friends who have lost their children. Mothers and fathers who will never be the same.

I am gripped with grief every time I enter a windowless family waiting room to tell a parent that their child is dead. I often wonder how they are doing now, months or years later. How do they move on the way my parents and my friends who have lost children have moved on?

This is the hardest thing I ever do in my job. I operate on beating hearts. I crossclamp aortas. I whip out spleens 20 minutes skin to skin. But this, this is the hardest thing I have to do as a trauma surgeon, telling parents their child is dead.

Last night at a trauma surgery professional meeting we were privileged to watch the Newtown Film documentary with the filmmaker and an ER physician who provided care that day and is a Newtown resident. It was a gut wrenching story about the evolution of grief. It followed the parents who lost their children in this particularly gruesome and entirely preventable way. The grace and dignity with which they tackled life after 12/14 was remarkable, inspiring, and heartbreaking. It followed the teachers, the students, and the first responders who saw and heard what was simply unimaginable in even our worst nightmares…until then. Until 12/14/12.

Carnage: 20 dead first graders. 6 dead educators.

We are having myriad civil discussions at this meeting on what we as a profession can do to reduce firearms injuries. To be sure it’s a careful line to walk in our current societal climate. Avid readers of this blog already know where I personally stand on this issue based on my experiences as a trauma surgeon and the fact that I am human.

But today, today I just can’t get my mind of those dead children. They were loved and cherished lives filled with infinite potential. A lone gunman whose mother thought it appropriate to have a semi-automatic weapon and multi-round bullets in her home took them all away.

They didn’t stand a chance. Not with that weapon. Not with that kind of ammo. All gunned down in <5mi.

How many of us wave good bye to our little tykes, back packs all snug on their shoulders, expecting them to return home at the end of the school day? My own child was a sitting in a first grade classroom not too far north of Newtown, CT on that day. Any of us could be these parents experiencing unimaginable grief.

I am once again listening to the words of Lin Manuel Miranda from Hamilton to try to buoy me through these emotions as a mother, as a surgeon, as a human with a soul.

In ‘It’s Quiet Uptown’ Eliza who has lost her son to gun violence sings:

“There are moments that the words don’t reach.

There is suffering too terrible to name.

You hold your child as tight as you can

and push away the unimaginable.

The moments when you’re in so deep,

it feels easier to just swim down.

…

There are moments that the words don’t reach.

There is a grace too powerful to name.

We push away what we can never understand,

we push away the unimaginable.”

Her husband Alexander sings:

“If I could spare his life,

If I could trade his life for mine,

he’d be standing here right now

and you would smile, and that would be

enough.

I don’t pretend to know

the challenges we’re facing.

I know there’s no replacing what we’ve lost

and you need time”

The chorus repeatedly adds:

“They are trying to do the unimaginable.”

The Newtown Film chronicles a community trying to do the unimaginable. While I cried through most of the film watching the grief unfold, the most powerful moment for me was when David Wheeler who lost is son Ben was testifying to a CT legislative task force. He said “The liberty of any person to own a military-style assault weapon and a high-capacity magazine and keep them in their home is second to the right of my son to his life.” That line took my breath away like a sucker punch to my gut.

The Newtown Film is powerful and difficult to watch but I hope that all of us Americans- parents, teachers, first responders, policy makers, legislators, and professional organizations – all of us see it. With this film, I hope that the national dialogue will become less contentious as we realize that no one, no parent, no school, no community, should ever have to suffer such imaginable grief.

Still en route to Disney for the marathon and in case anything happens to our luggage (and since I had two trips worth of packing to do) I brought on my new weekender duffel to carry my overnight and running gear along with my noodling around clothes for 3 days and rain gear if needed.

Before the reveal, I have to say that finding this bag was somewhat of an ordeal. I had struggled with my two existing “overnight” / “gym” bags for past 2-3 day trips. I always ended up with an extra bag for either running clothes or toiletries or something. What I really wanted was a generous bag that would hold a couple days of daywear, running stuff, and some nice going out stuff.

My inspiration was this amazing (now discontinued) Coach duffle I had given my husband last Christmas. It was just gorgeous to look at with soft as a baby’s bottom leather and sharp chrome hardware and it held a ton. For my past two trips without him I managed to coerce my better half into letting me use it. It was perfect for fitting everything and I was on a mission to find one of my own.

But I am me so I wanted one with a pop of color. Or some other feature that would make mine stand out as different from his when we did succeed on date weekends. I ran into quite a bit of trouble finding anything “for women” that was longer than 18-21in and anything targeting any gender that was not black or brown. I have also never been super into monogram bags that are egregiously overt in displaying brand identity. But I will admit that I did thoroughly research the luxury brands of Gucci, LV, and Burberry exploring sizes, colors, and possibly subtle patterns. In the end I had zero desire to pay the price of the blue book value of my car for a bag I would use only a few times a year, and certainly not one that was canvas – I don’t care how well it was coated or what the history is.

But I did want another investment piece that was quintessential me and would make me happy to use it for years to come.

At some point during my search my sister visited and commented on her Longchamp bag and how much mileage she had gotten out of it as a durable day bag. Of course she was talking about the well known Le Pliage line of brightly hued nylon bags with iconic leather trim/shape. Now these bags do come in various size but I did not want nylon. But I found myself checking out the Longchamp website to see what else they might have.

And, voila. There it was. It came in a color the manufacturer calls vermillion. Red has always been one of my favorite colors. I have a lot of red in my wardrobe. It’s my signature work color with my clogs and giggles. Vermillion also evokes my cultural heritage as well.

So this bag spoke to me immediately. The size. The color. The look. (In general I prefer smooth over pebbled leather and gold over silver toned hardware but neither were deal breakers given how challenging finding size and color were in this case.)

And today for this trip I debuted the bag. I packed before heading to work for the day in anticipation of a quick turnaround to the airport. My husband texted me this picture of our weekenders side by side with the message “Don’t they look lovely together” and it made me grin. They are, indeed a perfect pair.

This Le Foulonne leather extra-large travel bag is simple and spacious. Two internal slat pockets in the jacquard lining, rolled handles a removal shoulder strap, snap tabs to convert from a satchel to a duffle silhouette, and the iconic Longchamp leather button tab (subtle rather than over the top attention getter). It’s super light to and folds for storage without permanently taking on the folds in the leather.

Here it is filled with so much stuff and looking great at the same time.

While my original vision for this bag was short local trips of 2-3 nights I am delighted to christen it on our flight to Disney.

Heading out for the Disney marathon trip today (more on that soon – if I survive!) and amidst my combination of fear and excitement is the joy of debuting two new travel bags. I travel a lot and have been wanting more reliable and still stylish options for both a medium hall trip (think 3-5 days of work clothes, workout gear, and evening casual or black tie options) and a long weekend getaway (inclusive of noodling around clothes, at least one running get up, and an out on the town outfit). I will confess the latter are for date weekends/race weekends which I don’t do enough of but hey…Anyway, the point is these bags are in general for separate purposes.

This particular trip, however, combines a race weekend, a family Disney mini trip, and a 4 day conference with multiple evening outfit changes. So, my pre-race energy was amped by the joy of putting BOTH new bags to use.

So here is my new 26 in Tumi Larkin (accompanied by the Lo & Sons OMG)

Here are some views from the manufacturer.

To be sure, it is a heavy suitcase compared to many others on the market of this size. Without my stuff it checks in at 17lbs. But the design is gorgeous and construction is durable. The interior is split into a suited side (I fit 3 work appropriate dresses, spanx, and 2 pairs of heels on that side) and a larger compartment with two side zip compartments and a 3 pouch (one basic, on velvet lines, and one waterproof) carrier with a hook that doubles as the compression strap. The wheels are really smooth and allow for unencumbered 4 way motion. It also expands via solid brackets in the middle of the bag so no tipping over when expanded (but there is no way I would be able to do that and stay under 50lbs). Of course, it’s all backed by Tumi’s warranty and much lauded customer service.

This is an investment piece. I especially love the gold tone hardware that is stylish but not gaudy. I am looking forward to many trips for years to come with this medium haul suitcase.